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PRACTICAL OBSERVATIONS 



SJamnatiott: 



INOCULATION 



COW-POCK. 



BY JOHN REDMAN COXE, M.D. 

MEMBER OF THE AMERICAN PHILOSOPHICAL SOCIETY, AND ONE; 
OF THE PHYSICIANS TO THE PENNSYLVANIA HOSPITAL. 



Embellished with 
A COLOURED ENGRAVING, 

Representing a comparative View of the various Stage* of the 
Vaccine and Small-Pox. 



PHILADELPHIA: 



PRINTED AND SOLD BY JAMES HUMPHREYS, 

At the Corner of Walnut and Dock-streets. 



1802. 
[Copy-Right fecured according to Law;] 




INTRODUCTION. 



THE important advantages 
of Vaccination, or Inoculation for the Cow-Pock, 
appear to be so thoroughly established, and so ma- 
ny valuable treatises have been written on it, that 
any further attempt may be deemed a work of su- 
pererogation: But when it is considered, that this di- 
sease is comparatively new in the extensive regions 
of America -, and that those treatises have hitherto 
been chiefly confined to Europe -, when it is consi- 
dered likewise, that numbers are yet unsatisfied, or 
unacquainted with, the facts upon which the intro- 
duction of this invaluable disease is founded ; it may 
not perhaps be improper to add, the additional testi- 
mony in its favor which has accrued here, to the 
immense mass which is now contained throughout a 
great part of the civilized globe. 



VI 

A work on this subject will not I trust, be deemed 
cither uninteresting or useless to the Practitioners of 
America, many of whom from their diftant situati- 
ons, cannot so readily acquire information on this 
new and valuable addition to Medical Science.* 
When we reflect that the lives of thousands, are per- 
haps dependent on the speedy extension of this in^ 
valuable blessing, I hope I shall be exempted from 
any charge, but that of a desire to awaken the minds 
of parents and physicians, to the superiority of this 
disease over the small-pox. 

Having fortunately been instrumental, in introdu- 
cing this disease into Philadelphia and the adjoining 
country , I candidly confess, I feel a pleasure in the 
reflection which nothing should tempt me to forego : 
Nor are my feelings less agreeable, in considering 
myself as the very first person in this city, who actu- 
ally had it by inoculation here. I have proved in 
my own person the mildness of the Vaccine, and the 
perfect confidence I placed in the accounts of its im- 
mortal discoverer. 

It is proper here to observe, that the prophylactic 
power of the Vaccine had been long known. This is 
not the discovery to which Dr. Jenner lays claim. 



* One of the principal reasons which influenced the publication of 
the present treatise, arose from the numerous applications for informa- 
tion on the subject, which it was impossible to comply with in every 
instance. I request those gentlemen, whom I have thus apparently 
neglected, to pardon me, as my silence was altogether accidental. 



Vll 

He first experimentally proved, that the virus did 
not lose its specific property, by being transferred 
from one human subject to another by inoculation j 
and to him therefore is mankind indebted for the happy 
prospect it unfolds, of completely annihilating a dis- 
ease, whose name alone must ever be remembered 
with horror. 

It is not among the least remarkable circumstances 
of this discovery, that the fact of its preservative ef- 
fect against the small-pox should have been so long 
known, v/ithout any practical use being made of it! 
Like Columbus' egg, the induction now appears 
so simple, that we are lost in astonishment, it was 
not sooner verified ! It was reserved for the illustri- 
ous Jenner; and evinces the truly philosophic mind 
that readily combines important truths, which others 
overlook.- — This truly important experiment, was 
made on the 14th day of May 1796: a day ever 
memorable in the records of humanity, by opening 
to view a perfect security against the most ferocious 
and destructive disease, which was suffered to escape 
from the box of Pandora ! 

When the important advantages of Vaccination 
over Inoculation,* are generally known and proper- 
ly estimated, we may safely conclude the celebrated 

* I use the term Vaccination, in opposition to Inoculation, which 
certainly should now be appropriated solely to the Small-pox. Inde- 
pendently of the propriety of the measure, it prevents the unnecessa- 
ry addition of the name of the disease employed. 



vni 

author of the discovery will receive that universal 
homage he so richly deserves. The philanthropy 
he has evinced, in communicating it immediately to 
the public, in place of converting it to his own pri- 
vate emolument,* is worthy of the liberal profession, 
to which he is so bright an ornament; and, whilst it 
raises him in the eftimation of a grateful world, must 
certainly prove the ftxongeft reproach to thofe, who 
by an opposite conduct, hope to serve themselves at 
the expence of suffering humanity. 

Although I have met with a large proportion of 
the facts laid down by writers on this disease, and 
have never neglected for a single day to note every 
occurrence to which I had previously been a ftranger; 
yet I am very far from viewing the prefent perform- 
ance, as giving that complete view of every variety 
in the disease, which is only to be known by time and 
longer experience. Enough is said however, I trust, 
to point out the necessity of strict attention, in order 
to prevent our being imposed upon by the spurious for 
the genuine disease; an error, which by the false con- 
fidence impressed, has unfortunately been productive 
of consequences fatal to the patient, and of injury to 
the extension of this most valuable blessing. That 
this is not a false dread, must be very evident to the 
inhabitants of such places, into which the spurious 



* This truly deserving character, has, I have good grounds to 
idsert, spent upwards of £.6000 sterling, or full 25,000 dollars, in 
his various researches and experiments, relative to this disease. 



IX 

disease has been unfortunately communicated -, even 
here, where the knowledge of the disease has been 
more extended, and more easily acquired, it has been 
insufficient to prevent the occasional appearance of 
this insidious enemy, which has not failed to check 
the favourable impression of the disease, which many 
had previously entertained. To guard in some mea- 
sure against this evil, I have added an engraving re- 
presenting the various stages of this disease, which 
will give Practitioners a pretty good idea of its true 
character, until experience shall have more fully made 
them acquainted with it : It is taken from one of 
Dr. Jenner/s, which is excelled only by Nature her- 
self. To this I have taken the liberty to add the 
profile of the pustule on the respective days, as given 
by Messrs. Ballhorn and Stromeyer, and which I 
consider an interesting and useful addition, by exhi- 
biting more clearly a striking difference in the Vaccine 
and Small-pox. To those who are in possession of 
Dr. Jenner's invaluable engraving, it will appear, 
that I have in the view of the disease on the twelfth 
day, given that beautiful variety of the recession of 
the Areola, which is represented in the third plate of 
his treatise on the cc Variolas Vaccinae," and also in 
the treatise of Messrs. Ballhorn and Stromeyer; in 
place of the more usual appearance, which is repre* 
sented in the plate from which this is copied. 



I 2 ] 



PRACTICAL OBSERVATIONS, &c. 



Be 



BEFORE we enter upon the consideration 
of this highly important disease, it may not be improper 
to take a view of its origin ; which I shall be pardoned for 
presenting to the reader, in the words of Dr. Jenner him- 
self. (See his Enquiry, &c. p. 2 to 6.) 

" There is a disease, to which the horse, from his state 
of domestication, is frequently subject. The farriers have 
termed it the Grease. It is an inflammation and swelling 
in the heel, accompanied at its commencement with small 
cracks or fissures, from which issues a limpid fluid, pos- 
sessing properties of a very peculiar kind. This fluid seems 
capable of generating a disease in the human body (after it 
has undergone the modification I shall presently speak of) 
which bears so strong a resemblance to the small-pox, that 
I think it highly probable it may be the source of that 
disease.* 

" In this dairy-country a great number of cows are kept, 
and the office of milking is performed indiscriminately by 
men and maid-servants. One of the former having been 
appointed to apply dressings to the heels of a horse affect- 
ed with the malady I have mentioned, and not paying due 
attention to cleanliness, incautiously bears his part in milk- 
ing the cows, with some particles of the infectious matter 

* This Treatise it must be remembered, was written in 1798. 



12 

adhering to his fingers. When this is the case, it frequent- 
ly happens, that a disease is communicated to the cows, 
and from the cows to the dairy-maids, which spreads through 
the farm until most of the cattle and domestics feel its un- 
pleasant consequences. This disease has obtained the name 
of Cow-pox. It appears on the nipples of the cows in the 
form of irregular pustules. At their first appearance they 
are commonly of a palish blue, or rather of a colour some- 
what approaching to livid, and are surrounded by an in- 
flammation. These pustules, unless a timely remedy be ap- 
plied, frequently degenerate into phagedenic ulcers, which 
prove extremely troublesome. The animals become indis- 
posed, and the secretion of milk is much lessened. In- 
flamed spots now begin to appear on different parts of the 
hands of the domestics employed in milking, and sometimes 
on the wrists, which run on to suppuration, first assuming 
the appearance of the small vesications produced by a burn. 
Most commonly they appear about the joints of the fingers, 
and at their extremities; but whatever parts are affected, 
if the situation will admit, these superficial suppurations put 
on a circular form, with their edges more elevated than 
their centre, and of a colour distinctly approaching to blue. 
Absorption takes place, and tumours appear in each axilla. 
The system becomes affected, the pulse is quickened ; shi- 
verings, succeeded by heat, general lassitude, and pains a- 
bout the loins and limbs, with vomiting, come on. The 
head is painful, and the patient is now and then even affect- 
ed with delirium.* These symptoms, varying in their de- 
grees of violence, generally continue from one day to three 
or four, leaving ulcerated sores about the hands, which, 
from the sensibility of the parts, are very troublesome, and 
commonly heal slowly, frequently becoming phagedenic, 
like those from whence they sprung. During the progress 

* «.« It w : ll appear in the sequel that these symptoms arise princi- 
pally from the irritation of the sores, and not from the primary action 
of the Vaccine virus upon the constitution." Note of Dr, J, 



13 

of the disease, the lips, nostrils, eye-lids, and other parts 
of the body, are sometimes affected with sores ; but these 
evidently arise from their being heedlessly rubbed or scratch- 
ed with the patients' infected fingers. No eruptions on the 
skin have followed the decline of the feverish symptoms in 
any instance that has come under my inspection, one only 
excepted, and in this case a very few appeared on the 4 arms ; 
they were very minute, of a vivid red colour, and soon died 
away without advancing to maturation ; so that I cannot 
determine whether they had any connection with the prece- 
ding symptoms. 

" Thus the disease makes its progress from the horse 
(as I conceive) to the nipple of the cow, and from the cow 
to the human subject," 

It was for a considerable time supposed, that this idea of 
the "origin of the extraordinary disease in question was ill 
founded, because several attempts had ineffectually been 
made to excite the disease in the cow, by immediate ino- 
culation with the matter of grease ;* but it would seem from 
more fortunate experiments, that its real origin is here deve- 
loped. In Ring's Treatise, p. 14, &c. a veterinary surgeon 
is said to have actually succeeded in " producing the disease 
artificially in a cow, by removing a scab from the teat, and 
applying the recent blackish matter of grease to the absorb- 
ing surface of the sore." 



* This idea is opposed by the justly celebrated Dr. Woodville, 
whose experiments to elucidate this interesting point, entitle him to 
the greatest praise. — A knowledge however of the success of the 
experiment in other hands, which so often proved abortive with Dr. 
W. may be of service in guarding against the mode of drawing 
general conclusions, from negative experiments. We here see, all 
reasoning drawn from them, however plausible, at once falls to the 
ground by this single positive fact. In the same hasty manner, con- 
elusions have been drawn, that persons who have previously had the 
Small-pox, are exempt from the Vaccine $ which although it may be J 



14 

Mr. Ring at page 15, has given a very interesting letter 
from a Mr. Rankin, relating a case of disease accidentally 
produced on the face and hands of a farmer, by the fluid 
oozing from the heels of a horse labouring under the 
scratches, which spirted upon him when dressing him. 
The pustules induced, bore the strongest resemblance to 
the casual Cow-pox, and were attended with considera- 
ble fever, full quick pulse, violent head-ach, foul tongue, 
thirst, &c. 

At page 693, Mr. Ring says, " I am informed by Dr. 
Jenner, that in the case where the Cow-pox could be tra- 
ced by Mr. H. J. jenner from the grease, a boy, having 
drawn a string backwards and forwards over the heels of the 
horse, drew it repeatedly across his fingers, till he had caused 
an abrasion of the cuticle. Thus the subjacent parts were 
inoculated with the virus of the horse; and the disease re- 
sembled the Cow-pox ; the lymphatics exhibiting beauti- 
ful tints of red, in consequence of that affection. " 

Dr. Jenner has favored us with a remarkable case which 
came under his notice, of the system remaining unsuscep- 
tible of the variolous contagion, after having been affected 
by the matter issuing from the heels of horses. The in- 
disposition produced had been pretty severe. Six years af- 
terwards, the Doctor inoculated the person repeatedly, and 
exposed him also to the contagion of the small-pox, but 
without producing any effect. To this case is annexed a 
note, stating as a remarkable fact well known to many, the 
frequent failure of attempts to communicate the small-pox 
by inoculation to blacksmiths, who in the country are far- 



generally the case, is not so in every instance, as I shall hereafter no- 
tice ; hence patience is a great desideratum in experimenting. — Cows 
undoubtedly, as well as men, are not always in a state to receive the 
impression of this disease : — Hence the frequent failure by inoculation 
in one person with the very same matter, and with similar precautU 
ons, which produces it in ethers. 



*5 

tiers ; and asking if it may not now be accounted for, on 
rational principles.* 

Another instance is adduced by Dr. Jenner to prove the 
obscure appearance of small-pox, after the disease produced 
by the grease, at least occasionally. In the next case how- 
ever he attempts to shew, that this cannot be entirely re- 
lied on, " until a disease has been generated by the morbid 
matter from the horse on the nipple of the cow, and passed 
through that medium to the human subject;" — for the per- 
son who is the subject of this case, took the small-pox up- 
wards of twenty years afterwards. (See cases 13, 14, 15.) 

Though these cases do not completely prove the Vaccine 
to originate from the Grease; yet the two first must be al- 
lowed to render the idea extremely provable. 

Three men were affected from the heels of a mare with 
sores in their hands, followed by inflamed lymphatic glands 
in the arms and axillae, shivering succeeded by heat, lassitude, 
and general pains in the limbs. Two of them had passed 
through the small-pox, and described their feelings as very si- 
milar in both diseases. One of these was daily employed as 
a milker at the farm ; and in about ten days after washing 
the mares' heels, the disease began to appear among the 
cows. This fact certainly goes far in demonstrating the ori- 
gin of the disease; and the probability is increased by the 
subsequent information, that " a child of five years old was 
inoculated with matter taken from a pustule on the hand of 
one of these men : He became ill on the sixth day with 
symptoms similar to those excited by Cow-pox matter." 
Dr. Jenner was prevented ascertaining, whether the matter 
thus passing from the horse through the human constitu- 
tion, will produce a similar effect, as after passing through 
the cow, in consequence of this child dying before any trial 
was made with variolous matter. § 

* It would be satisfactory to have this fact further established by 
those medical gentlemen, whose situation in the country gives them 
greater opportunities of attending to it. 

§ This child's arm is the subject of Dr. Jenner's second plate* 



i6 

It appears to me, the foregoing facts are sufficient in the* 
mind of an unbiassed person, to establish the truth of Dn 
Jenner's important opinion of the origin of this disease. If 
more are deemed necessary, they may be found in Dr. Jen-- 
ner's invaluable treatise, to which I must refer, particularly 
to his interesting observations at p. 90 &: seq* 

Before I conclude this part of the subject ir may not be 
amiss to mention Dr. Jenner's opinion, of the probabU 
lity that other parts of the horse as well as the heels, are 
capable of generating the virus which produces the Cow- 
pox. 

" An extensive inflammation of the erysipelatous kind 
appeared without any apparent cause upon the upper part of 
the thigh of a sucking colt, the property of Mr. Millet, a 
farmer at Rockhampton, a village near Berkeley. The in- 
flammation continued several weeks, and at length terminal 
ted in the formation of three or four small abcesses. The 
inflamed parts were fomented, and dressings were applied by 
some of the same persons who were employed in milking 
the cows. The number of cows milked was twenty-four, 
and the whole of them had the Cow-pox. The milkers, 
consisting of the farmer's wife, a man and a maid-servant, 
were infected by the cows. The man-servant had previous- 
ly gone through the Small-pox, and felt but little of the 
Cow-pox. The servant maid had some years before been 
infected with the Cow-pox, and she also felt it now in a 
slight degree. But the farmer's wife, who never had gone 
through either of these diseases, felt its effects very severe- 
ly." See p. 62. 

As it is of great importance to determine with precision, 
the origin of this disease, I have been more full, than other- 
wise to many might seem necessary; but as this question 
involves in it the possibility of producing the disease amongst 
us, whenever we unfortunately may lose the infection, I 

* I shall in a future part give some interesting communications re- 
specting the domestic origin of the disease among our own cows. 



17 

have stated what will I think suffice to call the attention of 
those persons to it, whose time and opportunities may ena- 
ble them to do justice to the subject. * 

As I entertain but little doubt from what is above stated, 
that the origin of this disease has been satisfactorily traced 
by the illustrious Jenner, I may be permitted to add, that 
amidst our veneration for the cow, we should not forget 
our grateful tribute to the horse, for doubly proving, thus, 
a source of health and pleasure. Experiments must de- 
termine, whether the teat and udder of the cow by inocu- 
lation with the grease, are alone capable of elaborating this 
infection; or whether other animals may not be employ- 
ed so to modify it, that it may serve the same good pur- 
pose. It is an important fact deserving of notice, by those 
who may be disposed to pursue experiments on the sub- 
ject of this disease, that when it broke out among the 
cows of Grey's inn lane, (Woodville, p. 10.) of two hun- 
dred cows, four-fifths were eventually infected; the rest, 
which were not in milk, escaped the disease. This proves 
its non-contagious nature; but the object I have in view 
in mentioning it, is to ascertain if the cow in this state, is 
less liable to receive the infection by inoculation; for having 
vaccinated a cow in this situation twice, ineffectually, by 
five punctures in all, and with fresh matter, I am rather 
suspicious it may be the case. 

Having never seen the casual Cow-pox as it has been 
termed, that is, the disease communicated immediately from 
the cow to the human subject, I shall refer to Dr. Jenner's 
account, observing only, that it is to be viewed in the light 

* Great accuracy is requisite in conducting such experiments, that 
we may know every circumstance tending to render them successful, 
when it is necessary to recur to them for a supply of infection. They 
must chiefly be made in the country, from the greater facility of pro- 
curing the matter of grease, &c. than in town. 
[ 3 ] 



of an inoculated disease, although not effected with the 
point of a lancet, nor even perhaps through the medium of 
an abraded cuticle, though probably this is the case in most 
instances. It is said to be generally a more violent disease, 
which may partly arise from the greater number and mag- 
nitude of the pustules, than when communicated by art, in 
consequence of the greater extent of surface exposed to the 
infection in milking the cow. 

In order that it may be understood what clay precisely of 
the disease is spoken of in the following pages, I must re- 
mark, that the first day commences from the moment of 
the insertion of the virus, and is compleated at the same 
hour of the succeeding day; so that, when mention is made 
of any particular day, as the sixth, it is to be understood of 
the whole twenty-four hours, immediately following the 
completion of the fifth day. It may be thought unnecessa- 
ry to mention this; but some persons I believe, are not in 
the habit of counting the day of inoculation as the first, 
which becomes a source of error and confusion, from a wane 
of uniformity in a circumstance apparently trifling. 

This disease as communicated by inoculation, in its com- 
mencement much resembles the small-pox : Towards the 
middle or close of the second day when the operation takes 
effect, (that is thirtv-six to forty-eight hours from the period 
of inserting the virus), a light speck of inflammation may ge- 
nerally be perceived: This becomes much more conspicuous 
in the course of the third day, and in most instances bv the 
commencement of the fourth, a minute pimple may be felt 
rising above the skin, and surrounded by a circular inflam- 
mation at its base. It now gradually increases in size, and 
by the close of the fifth day begins to assume, (especially if 
viewed with a magnifying glass), that appearance which so 
much distinguishes it from the small-pox. This consists in 
the perfect regularity, and beautifully circumscribed form 
of the pock, which has a surface flattened, with a depressed 



*9 

centre, of a darker colour,* so as to give an appearance of ' 
elevated edges. In the small-pox on the contrary, by the 
sixth day, the inoculated part begins to assume an irregular, 
or angulated appearance, and its surface is not so flattened 
in proportion to its diameter. This circumscribed appear- 
ance is retained by the Vaccine during its whole progress* 
even during the process of scabbing, whilst the small-pox 
becomes daily more irregular, in consequence cf the conflu- 
ence of the adjoining pustules. (See the plate. )f 

About the fifth day, the pock begins to change from the 
red pimple to a vesicle containing a fluid, which through the 
cuticle somewhat resembles the colour of whey. This fluid 
is at its first formation in its most active state, and probably 
will be less liable to fail, if taken at this early period, than if 
delayed to a later day. From the sixth day to the tenth is 
mentioned as the proper period for collecting it; I shall how*- 
ever notice some exceptions to this hereafter. During this 
interval the pock augments considerably ; the flattened appear- 
ance becoming more conspicuous in proportion to its size; so 
that sometimes in a pock of nearly half an inch diameter, its 
elevation above the surrounding skin will scarcely, ;f at all, 
exceed the one tenth, or the one twelfth of an inch, evinc- 
ing at the same time, the total absence of the plump rotun- 
dity of the variolous pustule. About the eighth or ninth 
day, the pock having arrived to maturity, the constitution- 
al symptoms begin to shew themselves; the general indis- 



* This dark coloured speck in the centre, Mr. Addington says, 
" represents the cuticle still adhering in that spot to the skin under- 
neath." p. 16. 

f It is this peculiar appearance of the Vaccine disease, which is to 
be particularly attended to, in forming our opinion of its genuine cha- 
racter. The more it recedes from this standard, the greater is the pro- 
bability of its being a spurious disease which is excited. It may be 
proper to observe, when the Vaccination is performed with an infected 
thread, the subsequent pustule is sometimes of an oblong or oval fi- 
gure, though still retaining its regular circumscribed form. 



io 



position being preceded by swelling and pain of the pustule 
shooting up towards the axilla, (and shoulder occasionally), 
the glands of which now become swelled and painful, es- 
pecially on moving the arm, whilst the system sympathises, 
as evinced by languor, drowsiness, paleness, chilliness, and 
flushes of heat, head-ach, pain and fulness of the eyes, pain 
of the limbs and of the back, loss of appetite, nausea, and 
sometimes vomiting, an increased frequency of pulse, thirst, 
and white tongue. It is not to be supposed that these all 
occur in every patient ; on the contrary, it is difficult in 
many instances to detect the presence of any one of them • 
some or other of them however for the most part occur, 
and continue with greater or less violence, (seldom so as 
to confine the patient) from one hour, to two, three or 
more days, when they subside spontaneously, without any 
disagreeable consequence. The slight marginal inflamma- 
tion which has accompanied it from its first appearance, 
about the eighth or ninth day begins to augment very mo- 
derately, increasing more rapidly about the tenth or ele- 
venth days, so as to extend to one, two, three, or more 
inches in diameter, forming a most beautiful efflorescence 
or areola, which has been regarded as a proof that the ge- 
neral affection of the system had taken place : As however 
the areola does not always exist, and yet the prophylactic 
property of the disease is perfect ; we must not lay too great 
a stress upon it, nor be alarmed at its non-appearance, un- 
der an idea of the disease being merely local.* 

The centre of the pustule which always is depressed, 
now begins to assume a darker appearance ; this gradually 



* That the areola, even though it does occur, is not to be consi- 
dered as an absolute proof of the existence of the constitutional af- 
fection, may be inferred from its presence in a spurious disease, (see 
case i) in which not the slightest indisposition existed : Whereas in 
most instances the constitutional effects are more violent in the spu- 
rious disease. 



21 

extends to the circumference, and in three, four, or five 
days, the scab is generally complete, so that by the four- 
teenth day it is of a brown colour, darkest in the centre, 
and assuming a polished hue. This dark brown, or maho- 
gany appearance,* daily grows more intense as the fluid be- 
neath is absorbed ; at length it begins to detach itself at the 
circumference from the edge of the surrounding skin, still 
adhering at the centre beneath, till eventually, it falls off 
at different periods of time, generally from three to four 
weeks from Vaccination, leaving the skin sound, but most- 
ly with a slight depression or pit. 

About the eleventh day, the areola is mostly at its height, 
when it exhibits the appearance of a pink, or damask rose, 
accompanied with tumefaction and hardness of the limb, to 
the extent which it occupies. || Its appearance is sometimes 
alarming to those, who from not having before seen the 
varieties of the disease are not prepared for such a sudden 
alteration. It however subsides in a few days, and frequent- 
ly retires from the centre first ; leaving as it were, an inter- 
val of uninflamed surface, surrounded by a ring of efflo- 
rescence. A light blush however mostly remains till the 
cofapletion of the scab ; § the tumefaction generally de- 
clines with the efflorescence. 

This may be considered as a tolerably accurate account of 
the progress of the disease, as it has occurred to me. Some 

* This colour has been more properly compared I think by Mr. 
Addington to the colour of a dried tamarind stone. I may notice 
here that in the African, it rather seems to be influenced by the co- 
lour of the rete mucosum, as it generally I think approaches to a 
black. Since writing the above note, I am happy to add the opinion 
of Dr. Spense of Dumfries (Virg : nia), who says it precisely resem- 
bles " a piece of rough black sealing wax." 

U There is considerable variety in the actual grade of the colour 
of the areola, from a light p'nk to a deep crimson. 

§ It may be rather said to exhibit a dusky hue, attended with a 
desquamation of the cuticle to the extent of the tumour produced. 



22 



varieties remain to be considered, most of which I have 
likewise seen, and which I shall treat of in the same order. 
The success of the operation must depend in a great 
degree, upon the disposition of the system to receive the 
impression of the disease, when w r e are perfectly assured of 
the goodness of the infection. J say in a great degree, 
because even w T ith such a disposition existing, the best mat- 
ter may fail by an injudicious mode of Vaccination, so as 
to produce great local irritation, which effectually prevents 
absorption. This w r e also find is often the case in the 
variolous inoculation. In perhaps a majority of cases, the 
first attempt succeeds. As far as my experiments go, I 
have excited the disease in about three-fifths by the first 
attempt, or rather more than one-half. § Whether the ca- 
ges of failure would have equally opposed the variolous con- 
tagion is perhaps impossible to say; I rather apprehend it 
would have proved to be the case.* Mr. Ring, p. 508, re- 
lates the case of the brother of Dr. E. Bancroft, who " was 
inoculated for the small-pox eleven times, and once taken 
to a patient labouring under the disease, and inoculated in 
both arms with a large quantity of recent matter, but to no 
purpose; yet he afterwards caught the small-pox in the na- 
tural w r ay." Mr. Ring mentions three instances of five at- 
tempts, and one of sir, before infection took place, in his 
practice, and ascribes it to the constitution of the patient, 
since it was chiefly in children of a weak habit, that this 
difficulty occurred. t It is not however probable, that this 

§ By a reference to the tables I have drawn out of the first fifty 
cases which came in order under my care, it will be seen, that many 
attempts were made with old infection, in order to afcertain how long 
it might be preserved. I have therefore I believe, failed more fre- 
quently than others who have invariably employed recent matter. Set 
the last note of the tables. 

* Dr. Rollo mentions a child having been vaccinated ineffectually, 
who ten days before had also been inoculated for the Small -pox with- 
out success. Ring, p. 124. 

f See ccses 9 and 30 of the tables, far exceeding those nient ; cned 
bv Mr. Rin£. 



23 

weakly constitution should alone be the cause , as indepen- 
dently of my having succeeded frequently in the first attempt 
on weakly children, many of my patients in whom it failed, 
were by no means to be classed in this description. Although 
we cannot account for it, the fact remains certain, that one 
person more readily receives this disease (as well as other 
diseases), than another; and that this disposition varies in 
the same person at different times. 

The appearance of the speck of inflammation indicating 
the success of the operation is also very various. In gene- 
ral we may very accurately perceive it about the commence- 
ment of the third day. In several cases 1 have however ob- 
served it evidently early on the second day, or between 
twenty-four and thirty hours from Vaccination. I speak 
here only of such cases which actually succeed, for some- 
times a considerable inflammation takes place in a few hours, 
with great itching, and even an elevation of the cuticle as 
if a pustule was commencing. Where this occurs, we may 
almost invariably, perhaps always, predict the failure of the 
attempt. This is likewise generally the case in the small- 
pox, when the svstem is disposed to reject it. This species 
of local irritation I have experienced repeatedly, in the at- 
tempts I have made to produce the Vaccine a second time 
in myself; but which have hitherto failed; the inflammati- 
on disappearing about the fourth day.* 

It sometimes happens that the disease instead of becoming 
perceptible at this early period, does not shew itself till a ve- 
ry late date. In the Medical Review for April 1800, Mr. 
Taynton gives the case of an infant, in which no appear- 
ance of success took place till the twelfth day ; from which 
time it ran its course very rapidly. In the Medical Journal 
for May 1800, the Rev'd. Mr. Finch gives an instance of 
the pustule not appearing till the eighth day; and in another 
not till the jifieenth. 

* Since writing the above, I have succeeded in exciting a apurio** 
pustule. See the tables - % case i. 



24 

Doctor Cappe says, cases have occurred, in which there 
has been no appearance of a vesicle till the ninth day; and 
Mr. Ring has known two instances in which it did not ap- 
pear till the fifteenth day; and one, not till the sixteenth. 
" It is however certain (says Mr. Ring, p, 339) that in 
many cases the disorder makes a greater progress by the se- 
venth day, than it does in others by the twentieth."* 

The I\tedical Committee of Rheims mention the delay 
of the appearance of success in Vaccination as far as the 
twenty -second day. See Husson's Becherches, p. 29. 

By referring to case 6, in the tables, an instance will 
there be seen of this dormant state of the Vaccine virus for 
eighteen days. The Rev'd. Mr. Holt in the Medical Jour- 
nal for 1799, mentions a curious fact somewhat analogous. 
" I inoculated, says he, near thirty, twice or thrice, appa- 
rently without effect, allowing an interval of five or six days ; 
but though they sickened from the last incision, a pustule 
regularly appeared wherever I had formerly inoculated them, 
as if the dormant matter had been roused by the activity of 
that last inserted." 

I may add to this, that I have since met with three or 
four cases in which the previous Vaccination came on, after 
a weeks interval, upon the successful progress of a second 
attempt. 

The same variety exists in the Small-pox as in the Vac- 
cine before success is apparent. Dr. Odier of Geneva men- 
tions seventeen days; and Mr. Ring (p. 383) asserts that 
cases have occurred, where the symptoms of inflammation 
have not appeared till twenty-nine or thirty days after the 
operation. 

As the appearance of inflammation, indicating the infec- 
tion having succeeded, varies so considerably, so also does 
the advance of the pustule, now commencing its progress. 
In most cases a fluid cannot be distinctly perceived till about 

* Where the pustule does not appear as early as usual, its progress 
is generally more rapid. 



2J 

the fifth day. I have however had one instance in which I 
not only perceived, but actually obtained matter on the 
ninety-third hour from the period of Vaccination. As I 
obtained it without any difficulty, I concluded I might have 
discovered its existence six or eight hours previously, or 
three days and a half from inserting the infection.* 

From what has been previously stated of the great variety 
e progress of this disease, it may be readily concluded, 

t no absolute number of days from Vaccination can be 
fixed on, for taking the matter for future practice. I have 
taken it in one case from the eighth to the fifteenth day 
inclusive; from another, a patient of Dr. Hewson's, I pro- 
cured matter on the eighteenth day, with which I produced 
a most perfect disease. I must however mention, that the 
progress of the Vaccine in the case of Dr. Hewson's above 
alluded to, had been suspended by the measles. As this 
case is considerably interesting, I have Dr. Hewson's per- 
mission to make the letter public which contains the detail. 

" Dear Sir, 

" On Friday the 17th of December last, I ob- 
tained on the point of a lancet, some of the Vaccine virus 
from Mr. M 's child, and having previously moistened 
the same with a small particle of water, I inoculated 
Sarah Wattles aged ten months, and Maria Wattles aged 
twelve years. This was the order of the inoculation, which 
I have thought worth noticing, as in Sarah Wattles it did 
not succeed, but in Maria Wattles, where I was obliged still 
further to dilute the matter, the inoculation took effect. 

" On Thursday the 23d, (the seventh day) examining 
Maria Wattles' arm, I discovered a small limpid vesicle 
at the place of inoculation ; the skin immediately surround- 

* In this case the pustule did not advance more rapidly than usual 
to its termination. On the contrary I obtained matter till the tenth 
day inclusive, when the areola began its career. Case 43. 

[4 3 



i6 

ing this vesicle was of a fine vcrmillion colour, and hard to 
the touch. The mother informed me, that she had ob- 
served some signs of inflammation the day before, when I 
had omitted to visit the child. The vesicle gradually in- 
creased till Wednesday the 29th, (thirteenth day) when I 
perceived a small scab in the centre, i immediately inocu- 
lated with the matter taken from this child, the children of 
Mrs. Levis, Maria, Sophia, and David, occupying the up- 
per story of the same house These children were brought 
down stairs for the purpose. 

" Upon repeated inquiries I never could learn, that the 
child suffered any general indisposition until the evening of 
Tuesday the 28th, (the twelfth day) when she was seized 
with sickness at her stomach and frequent vomiting. These 
symptoms continued the next day, when I found the skin 
hot and dry, and pulse frequent ; I could not ascertain the 
number of strokes in a minute, the child being very restless. 
I ordered some antimonial wine as an emetic to be given in 
the evening, and requested the mother to give her the infu- 
sion of senna the following morning as a cathartic. 

" Tuesday the 30th, (fourteenth day) the medicines have- 
operated freely ; the child still continues fretful, and has con- 
siderable fever. The scab is nearly formed. I directed ten 
drops oi antimonial wine to be given four times a day, mild 
diluting liquids to be drank freely, and the child to be kept 
moderately warm. On Sunday the 19th of December, 
(third dav of Maria W's. inoculation) Alexander Wattles 
about eight years old, had brought the measles to the house. 
Delia Wattles had taken them on Saturday the 2.5th; and 
#. Wattles lay at this time in the cradle with all the symp- 
toms of the measles. These circumstances led me to sup- 
pose Maria's indisposition to be the same disease ; and this 
opinion was strengthened by the appearance of an efflores- 
cence on Friday the 31st, (fifteenth day). It was not till 
Sunday the 2d of January, that any pustules appeared. They 
were confluent and left no doubt of the disease being the 
small-pox. The pustules began to dry on Tuesday the 



27 

4th of January, (nineteenth clay of Vaccination) and the 
child went regularly through the disease. 

" I have already mentioned that I attempted to inoculate 
Sarah Wattles with the Vaccine virus. On the third day 
from inoculation I observed a small purulent pustule which 
disappeared on the fifth. She took the measles as related 
above. She had but just recovered of this disease, when, 
to wit, on Thursday the 6th of January, she was covered 
with a scarlet eruption, which I apprehended to be the small- 
pox. This though of the distinct kind, never filled proper- 
ly, and at last proved fatal, carrying her off on the seventh 
day. 

Two of Mrs. Levis's children, Sophia and David, took 
the Vaccine infection from the first inoculation. On Tues- 
day the 4th of January, (seventh day) I found them setting 
with Mrs. Wattles' children, the mother wishing them to 
take the measles. My anxiety was very great lest they 
might take the small-pox. On Tuesday the 1 Jth of Janua- 
ry being the fourteenth day after inoculation, Sophia Levis 
had a slight eruption on the face and breast, a dry husky 
cough, and a considerable flow of tears ; the disease was 
very light. In this child the areola which usually accom- 
panies the Vaccine disease did not appear till the nine- 
teenth day after inoculation. It was on the eighteenth day 
that you took some matter from the pustule, and you will 
recollect that there was then no appearance of an areola. 
Upon inquiry I learnt, that you succeeded with this matter 
in giving the Vaccine disease, 

" With great respect and esteem, 
M Yours, 

Jpril 30th 9 1802, " Thos. T. Hewson." 

I believe the testimony of most Practitioners, is in favor 
of obtaining the matter as early as possible to insure success, 
as it is then supposed to be in its most active state. At 
what point we must stop, seems as yet to be undetermined. 
J)v f Odier, of Geneva, has considered it as most proper to 



28 

be taken when the efflorescence is complete ; whilst the il- 
lustrious author of this important discovery, considers 
this efflorescence as a " sacred boundary beyond which the 
lancet should not pass.'* Again, Dr. Cappe, and others, 
consider the matter as proper for Vaccination as long as it 
continues limpid ; and by others we are recommended to 
take the matter on the eighth day, or eight times twenty- 
four hours from the period of Vaccination : 1 have as above- 
mentioned, taken matter, in a case of the most perfect ap- 
pearance and regularity, on the fifteenth day,* when the 
areola had nearly declined; this I have done in several in- 
stances-, from one I took it on the twelfth day, when the 
areola extended perhaps full three inches from the pustule, 
which was beginning to decline. (Case 22.) These may 
suffice to shew its safety, where the matter continues lim- 
pid, and the scab has not too far advanced. Dr. Cappe 
says, Dr. Woodwille informed him " he had twice inocu- 
lated on the thirteenth day from patients, in whom the di- 
sease was so far advanced, that he could only obtain a little 
moisture from the margin of the scab; yet he was success- 
ful." 

Were we to consider the presence of the areola, as the 
point beyond which we should never infringe, we should in 
frequent instances be unable to decide: How are we to 
judge when this "sacred boundary" does not exist, or 
how can we properly estimate its appearance in the dark 
skin of an African ? As a general rule I think it may proper- 
ly be retained; but we shall all, probably, in our practice, 
find exceptions to it. I should rather be disposed to adopt 
as a rule in taking the matter, that idea which restricts it to 
the eighth day. I speak of those cases which advance 
with due regularity ; because this day embraces usually the 
most tardy, and most rapid cases. It will also for the most 
part be in unison with the former; but to this we shall like- 
wise find exceptions, as the areola sometimes commences 

* -See p. 15. 



2 9 

on the fifth, sixth, and seventh days.* Although I would 
prefer taking matter at an early period of the disease; yet 
my opinion, formed from the few experiments I have made 
on this point, leads me to conjecture, that when the pustule 
has exhibited the character of the real Vaccine, no danger 
is to be apprehended from using the matter, even although 
the areola be formed, provided the fluid continues limpid, 
and the scab has not too far advanced : I should never hesi- 
tate to employ such matter, especially if none other offer- 
ed.§ 

* If the pustule runs its regular course, though quick, it is a per- 
fect preservative. And why should not this be the case as well as 
when its progress is preternaturally slow ? Husson, p. 29, mentions 
the areola on the eighth day. If the areola always existed, and if its 
actual presence could be always detected, I think that it would be 
the most accurate criterion ; but as this is not the case, so neitherjftiall 
we find the disease on the eighth day in many successful cases, suffi- 
ciently advanced to procure infection, see p. 23, 24. of cases not ad- 
vancing even as late as the twenty-second day: Hence the difficulty 
of fixing on any point of time, which shall be exempt from any ir- 
regularity. 

§ In the Medical Repository, Vol. V. p. 348, in answer to an in- 
quiry on the necessity of establishing a point of time for taking the 
Vaccine infection, Dr. Waterhouse considers the limpid state of the 
matter as a fallacious criterion j giving as a reason that " in the rising 
of a vesicle from almost any cause, the scarf-skin separates from the 
true, and a portion of the superfluous water of the blood, and some- 
times of the coagulable lymph, is found under it." He adds, " I have 
known this limpid fluid exude in considerable quantity from the Vac- 
cine pustule that has been too much irritated by pricking, and exhaust* 
ed of its virus. It gives a mining, glazy appearance to the thread.'" 
I cannot however acquiesce in this reason, because I cannot suppose 
any other vesicle is likely to be taken for the Vaccine ; at least when 
it is more generally known. I do not think it probable that any per- 
son acquainted with the Vaccine would be liable to err on this point. 
And I must confess I do not feel satisfied with the idea that the lim- 
pid fluid exuding from the Vaccine pustule, which has been too much 



3 o 

In the quantity of matter to be obtained from a patient 
in this disease, great variety exists. In a disease consisting 
for the most part of a solitary pustule, it may be concluded, 
that in general, it does not amount to any large propor- 
tion §. In several instances, where from the beautiful ap- 
pearance of the pustule I had anticipated the procuring a 
considerable quantity of matter ; I have scarcely obtained 
sufficient to moisten the point of my lancet. This was the 
case with one of the most perfect pustules 1 have seen, al- 
though previously to its scabbing, I think it was upwards of 
one third of an inch diameter (See Case 38). In other 
cases however, a pock of less diameter than a small pea [| has 
yielded much more matter than it appeared to me to be ca- 

irrltated by pricking, has been exhausted of its virus. How are we 
to determine the point at which we should cease to irritate the pustule 
by pricking it ? I have not hitherto found the effect alluded to, nor 
do I apprehend much danger from it. If the matter is taken away 
incautiously, and unnecessary irritation is employed, lean suppose a 
change in the properties of the secreted fluid. I have mentioned a 
case in which I obtained matter daily from the seventh to the fifteenth 
day, or above a week ; in which the areola had nearly subsided be- 
fore my last attempt j yet, with perhaps forty or fifty punctures, the 
matter continued good to the last, as I proved by its efficacy, thirteen 
days after having been taken, in producing a disease which effectually 
guarded against the small-pox. 

A thread when fully impregnated with the Vaccine infection, has 
always to me had a shining glazy appearance. A moderate solution 
of gum arabic will give an accurate idea of the Vaccine infection, on 
glass, on a lancet, and on thread. {See its Analysis, p. 32.) 

Although I thus differ on this point from Dr. Waterhouse, I am 
satisfied of the propriety of establishing eight times twenty-four hours 
as the point of time for taking infection. 

§ Although in most cases only a single pock appears, yet now and 
then one or more besides, occur. See case 11. 34. 42. 

|| Dr. Husson says he has seen a Vaccine peck not larger than a pin's 
head j but which produced in another a pock of the usual size. The 
quantity of infection is by no means dependant on the size of the pock. 



pable of containing at one time ; which satisfies me of the 
propriety of die opinion of Dr. Cappe, that it is partly 
supplied by secretion. It will often continue to exude for 
a considerable time from the small punctures made in the 
vesicle. One case I met with, in which the pustule, with- 
out being of uncommon magnitude, yielded sufficient mat- 
ter to coat over a piece of glass, equal to about a square 
inch, three or four times amply, and to imbue completely a 
thread of more than a foot in length. Upon a moderate 
computation I should suppose it yielded enough to have vac- 
cinated two hundred persons (See case 25).* In some few 
cases I have obtained matter five or six days successively ; 
and in the one above mentioned, eight days ; whilst others 
have yielded it only one, or at most two days. It is there*- 
fore of the highest importance to pay great attention to se- 
cure the matter at the proper time, and never to suffer an, 
opportunity of taking it to pass. From inattention to this 
point, I have heard Physicians asking for Vaccine infection, 
who but a week before, had said they had under their care 
several cases in the finest state for taking it. Their mode 
was simply to depend on the quantity they obtained on the 
point of a lancet, for a succeeding Vaccination. This is 
not the method to secure so perishable an article. Phy- 
sicians will without great attention, have to lament its loss 
when they most desire to employ it. I shall in a future 
part endeavour to point out the best mode of preservation. 

I cannot perhaps in any part more properly than here, 
introduce a chemical analysis of the Vaccine matter made 
by citizens Husson and Deputren, and given to us in Dr. 
Moreau's " Historical and Practical Treatise on Vaccine 
Inoculation." (See Ring p. 790.) This Analysis although 
ingenious, does not seem likely to be of any practical ad- 
vantage. 

* I supplied upwards of twenty Physicians with matter from this 
case alone.-— I might have procured much more from it, if leisure had 
permitted. 



32 

" When exposed to the air, it readily dries, without 
losing its transparency. It acquires the hardness of glass ; 
and forming a scale, adheres like a varnish to the surface 
upon whkh it is applied. It oxydates iron. If left to dry 
in the Vaccine vesicle, it forms itself into small and hard 
globules. When liquid, it readily dissolves in water ; and 
when solid it enjoys the same property. 

" When exposed to heat, it presently becomes turbid ; 
exhales a slight odour of carbonate of ammonia ; and is 
soon converted into a light cellular charcoal. It produces 
no alteration in the colour of syrup of violets ; nor in that 
of tincture of turnsol. 

" When tried with alkohol, nitrate of mercury, nitrate 
of silver, or nitric acid, it affords a white precipitate; which 
will neither dissolve in potash, nor in the muriate of Am- 
monia. The concentrated sulphuric acid, oxalic acid, the 
vapour of oxygenated muriatic acid, potash, barytes, and 
muriate of ammonia, neither produce the least action upon 
it ; nor alter in any manner, its external qualities. It seems 
t® consist of water and albumen ; of which the proportions 
are not known.' ' 

To this I may add, that it does not appear to me to pos- 
sess any taste ; though it seems to have the glutinous sen- 
sation of a gummy solution, leaving a slight degree of that 
asperity on the«tongue, which is produced by unripe fruit. 

With respect to the constitutional effects in this disease, 
there is considerable difference in time and degree. In in- 
fants as far as I have seen they have been almost invariably 
light. Indeed in several instances I have been unable to 
ascertain the slightest indisposition. Even in a variety of 
instances where they were teething, or had slight com- 
plaints of the bowels, the symptoms did not appear to me 
to be greater, than might reasonably be ascribed to the ac- 
companying irritation. 

Dr. Jenner has recorded (p. 131) that the Vaccine virus 
was inserted into the arm of a child about twenty hours old, 
who went through the disease without apparent illness, yet 



33 

was found effectually to resist the action of variolous mat- 
ter with which it was subsequently inoculated." I vaccina- 
ted mv youngest child when only three weeks old, in whom> 
although the areola extended nearly from the shoulder to 
the elbow, I discovered no marks of indisposition during 
its progress ; yet he has withstood the variolous action in 
three successive inoculations by six punctures, as well as by 
exposure to a man labouring under the Natural Small-pox. 
I cannot however, though so fully acquiescing in the truth 
of the benignity of this disease, accord with those gentle- 
men who consider the constitutional disease by no means 
essential to the permanent efficacy of the Vaccine. It ap- 
pears to me an absolute truth, that a constitutional affection 
must occur, however slight it be, to produce the astonish- 
ing change we find effected in the system. It seems ut- 
terly impossible a mere local disease could suffice to produce 
this general effect. I shall however extend this argument by 
stating, that the Revd. Mr. Holt, in the Medical Journal for 
December 1799, has mentioned the cases of William Neil of 
ten years, and Hannah Beal of six years of age, who had 
each above one hundred pustules in different parts of their 
bodies, which assumed precisely the appearance of that given 
by inoculation, except that they were smaller: no com- 
plaint of more than ordinary indisposition was made in ei- 
ther case." Eight children vaccinated from the matter of 
these pustules had the disease in the mildest form. These 
cases, whilst they evince the mildness of the Vaccine, shew 
the existence of a constitutional affection, without which 
such a general eruption could not have occurred. I have 
met with one case in which about the eleventh or twelfth 
day, a true Vaccine pustule formed upon the inside of the 
right knee : now there can scarcely exist a doubt in this 
case of a constitutional affection; yet it was so very slight, 
that, except the pain of the axilla, it was not to be percei- 
ved (case 42.) On these cases then I would ground my 
[ 5 1 



J4 

opinion, that a constitutional effect must take place,- to se- 
cure the system from future danger of Variolous infection.^ 

This fortunate exemption from, or rather moderation of 
febrile action, is however, not universal. In various in- 
stances, even in children, the symptoms are considerable, 
tho' rarely sufficient to produce alarm. The pain arising 
from the inflamed and tumid state of the axillary glands,, 
in manv instances is considerable for a day or two, or even 
longer ; thoi where it exceeds a moderate degree, it ap- 
pears generally to depend on the too free use of the arm 
whilst the glands are in the above state; and hence it usu- 
ally is greater in adults than in children, because they 
are unwilling to suspend their daily occupations. This is 
not however always the case, for we often see examples of 
continued labour, without the slightest increase of the con- 
stitutional affection, even when this is apparent. 

When the pain of the axilla exists, I have generally ob- 
served a pain of the part vaccinated, extending upwards to 
the axilla, as if in the course of the lymphatics. This pain 
is sometimes very considerable, being accompanied with a 
burning or stinging sensation, and with more than usual 
tumefaction and hardness of the surrounding cellular mem- 
brane. 

The absorption of the virus differing as we have seen 
very materially in different people, it may reasonably be 
supposed, (as really is the case) that considerable variety ex- 
ists in the commencement of the axillary inflammation and 
subsequent indisposition. It is in the actual state of inflam- 
mation of the axillary glands, that animpiudent use ©f the 

* No one I believe will doubt the necessity cf a general affection of 
the system in the small pox, to secure it against a future attack : most 
Practitioners must have e-ther seen, or read of cases of a perfect local 
variolous pustule, which by no means proved a preventive to the fu- 
ture attack, of this complaint. I shall in a subsequent part give some 
very strong instances of a second attack, of small pox, neither of 
which were merely local j but attended by every requisite which cast 
prove a constitutional affection. 



35 

arm may tend to prolong the disease ; and hence 1 have seen 
the pain continued for full three weeks ; accompanied with 
considerable tumefaction of the arm, and a blush of inflam- 
mation, extending to the wrist and above the elbow. 

The febrile symptoms vary very considerably. I have 
already mentioned that in some persons, especially children, 
they are not evident ; whilst in others, the disease has been 
accompanied with all the intermediate grades of drowsiness 
and head ach, up to chills, pain of back and limbs, and 
even nausea and vomiting. This is seldom the case ; so 
seldom indeed, that I must confess, I believe with Dr. Jen- 
ner, these violent symptoms arise not necessarily from the 
disease, but from the accidental irritation and consequent 
inflammation of the vaccinated part. In confirmation of 
which I can safely affirm, the only considerable cases of 
fever 1 have met with in this disease, have arisen after the 
tenth and twelfth days ; when an ugly sore has been induced 
by rubbing ofF the scab in its forming state, or great in- 
flammation has taken place by the irritation of rough 
clothes, &c. Previous to this, a moderate degree of febrile 
indisposition and axillary inflammation was all that was 
complained of; whereas at this period, great fever, head 
ach, pain of back, nausea and vomiting, took place. I shall 
have occasion shortly to say more on this point ; 1 shall on~ 
ly add at present, that this occurrence is not uniform, even 
when continued irritation would lead us to anticipate the 
most disagreeable effects. In one case of a black child of 
about a twelvemonth old, about the fourth day, the apex 
of the small pustule which was forming was rubbed ofF, 
and this was successively the case every day or two, nearly 
seven or eight times, owing to her tight and rough clothes. 
She had a slight indisposition on the eighth day with pain 
in the axilla, the former of which I ascribed to her teeth, 
three of which came through at this period, and though I 
fully expected a disagreeable sore, yet by the sixteenth or 
eighteenth day it was nearly dried away, without producing 
any inconvenience. About a month after this, I inoculated 



3 6 

the child for the small pox, under a firm persuasion that 
she would take the infection • the three punctures I made 
inflamed slightly, and advanced to the state of pustules, 
which never completely maturated, but dried away about 
the eleventh or twelfth day, without producing any erupti- 
on, or any febrile indisposition (case 18). 

From the earliest appearance of the pustule, a slight de- 
gree of inflammation surrounds its base. This scarcely ap- 
pears to enlarge, except from accidental irritation, till to- 
wards the close of that period when the constitutional 
effects seem subsiding, and which in most of the cases I 
have seen was on the tenth day. At this period it begins 
to augment pretty rapidly ; in some instances, it has not 
diverged from the tumour mere than half an inch, whilst 
in others it has extended from two to four, five, and nearly 
six inches. This inflammation, known by the name of the 
efflorescence and areola, is mostly of the same circumscribed 
circular appearance of the pustule, but at times it diverges 
unequally, its existence does not seem to be essential to 
the perfection of the disease, although its presence is desi- 
rable, from its being most frequently present. It was for a 
considerable time regarded as a proof of the certainty of 
the constitutional influence of the disease on the system ; 
which, without its presence was viewed as a mere local 
affection; Mr. Ring however expresslv mentions, that he 
has known " several cases where there was a total ab- 
sence of areola," yet in none had he known the patient 
capable of receiving the infection of the small pox. I have 
seen two cases of this kind, both of which have since been 
ineffectually inoculated for the small pox ; so that I feel 
perfectly assured of the efficacy of the Vaccine, even when 
unconnected with this peculiar appearance. 

I have stated that the areola does not always occur : I 
have also remarked, that a moderate degree of inflamma- 
tion surrounds the base of the tumour from its commence- 
ment, even when no areola follows. As these two grades 
therefore seem totally unconnected, although the areola 



37 

when it takes place, appears only to be an extension of the 
former, I have occasionally noted it down under the name 
of the secondary inflammation, to distinguish it from the 
primary or permanent one. The induration of the sur- 
rounding skin is more or less considerable as the areola ad- 
vances, and generally declines as the efflorescence recedes. 
1 have already mentioned the difficulty of ascertaining the 
presence of the areola in the black skin of the African • 
In the mulatto it is in most cases sufficiently evident. I 
have always considered the above mentioned tumefaction 
and induration of the surrounding skin as the sole criterion 
of its existence in the negro. As I have met with seve- 
ral instances of the absence of this state of the skin in the 
negro, I have considered it as evincing the non-existence of 
an areola. The two cases above mentioned were white, 
in whom I could make no mistake on this point: I leave 
it to be verified therefore, by those whose greater sources 
of observation on the negro, may qualify them to deter- 
mine it. 

As I have seen cases in which no areola existed, so I 
have also met with several instances, both of its early and 
tardy appearance. The early advance, as mav be supposed, 
is in those cases which have been followed rapidly by the 
subsequent changes. This was remarkably the case in my 
own person. By the commencement of the fifth day, two 
very fine pustules were progressing, with an efflorescence of 
nearly one fourth of an inch, at which period, I experienced 
considerable head ach and drowsiness ; on the sixth day, 
these symptoms had augmented, and shooting pains, ex- 
tending from the pustules to the axilla, were plainly per- 
ceived. The axillary glands were slightly enlarged. The 
efflorescence had advanced considerably, Avith slight tension 
and tumefaction of the parts. By the eighth day the areo- 
la was between two and three inches in extent from the 
pustule, or about five inches in diameter ; by the 10th day, 
or the usual time of the areola forming, the pustules were 
nearly scabbed over, of a dark mahogany colour ; the efflo- 



38 

rescence had gone entirely by the twelfth day, and one of 
the scabs fell off on the fifteenth, and the other on the six- 
teenth day, both leaving a second scab beneath, which fell 
off on the twenty-third and twenty-eighth days. 

Another instance came under my notice, of a child whom 
1 vaccinated nine times before infection took place (case 9). 
From this child on the seventh day I obtained matter. On 
the Sth a scab was forming with a slight areola, which was 
perceptible the preceding day. About the sixteenth day 
the scab fell off, leaving another beneath. On the twenty- 
first day I inoculated her in two places with variolous mat- 
ter, taken the preceding day from a patient labouring under 
the natural small pox. The punctures slightly inflamed for 
three or four days and then gradually dried away. It is re- 
markable in this case, that the matter I employed for Vacci- 
nation which took effect, was taken on the eighth day 
from a child, in whom the areola did not occur till the 
eleventh ; which last case was vaccinated with infection 
taken on the eighteenth day of the disease, one day only 
antecedent to the areola.* In one other case the areola be- 
gan on the seventh day, and by the ninth was nearly gone, 
the scab being partly formed (case 42). It may not be un- 
interesting to add, that this case I vaccinated with infection 
taken from a secondary pock on the arm of her sister, 
about two inches above the original one, on the twelfth day 
from vaccination, and the third or fourth of its appearance. 
-About the tenth or eleventh day, a Vaccine pock appeared 
on the inside of the right knee. This case I have before 
adverted to, and these, are the only two cases I have met 
with, of any other pustule than on the vaccinated part ; I 
except the appearance of pimples which are not uncom?* 



* I notice this to prove, that the early or tardy appearance of the 
disease, does not influence such as are produced from its infection* 




39 

moil, and which probably may depend on the Vaccine, 
Variolous inoculation failed in this instance. f 

1 cannot tell the latest period of the appearance of the 
areola. I have mentioned a case above from which I took 
matter on the eighteenth day, at which time the areola ap- 
peared just commencing (Dr. Hewson's letter, p. 27). I 
have seen it several times as late as the twelfth day. 

It might be supposed the efflorescence would occur quick- 
ly, in proportion to the rapid progress of the pustule, — but 
this does not seem to be the case. In the instance formerly 
noticed as yielding matter on the latter end of the third day, 
the areola did not commence till the tenth day; nor did the 
scab complete itself before the usual period. Case 43. 

The heat of the vaccinated part appears to be considerably 
augmented ; how much the thermometer would indicate, I 
have never tried. A more troublesome attendant on the 
areola than the heat, is a violent sensation of itching. It 
is of a burning stinging kind, resembling I think the sting 
of nettles; and requires the utmost exertion to avoid scratch- 
ing. This itching sometimes extends several inches. It is 
generally bounded by the circumference of the areola,* and 
is one of the most unpleasant symptoms, though not always 
equally violent; in children it has to me appeared a chief 



f In one case which came under my care, an inflamed circle com- 
menced about the beginning of the fifth day, extending by the evening 
to nearly an inch from the pock ; but by the evening of the sixth, it 
had totally disappearedy and the true areola did not commence till the 
close of the eighth day. I could not ascribe this appearance to any 
particular cause, and it is the only instance of the kind I have seen. 

* Though it is generally towards the close bounded by the extent 
of the areola, yet we find it occasionally appearing at an earlier peri- 
od, as the fifth, sixth, seventh, &c. days, before the areola had com- 
menced, and extending then to two or mete inches from the pustule. 
Perhaps the extent of the itching may generally denote the future ex- 
tent of the areola, as I have noticed in several instances. I have seen 
■\X decline before the areola commenced. 



4° 

cause of their fretfulness and anxiety, even when the febrile 
indisposition appeared but very trifling. f 

In addition to the varieties existing in the appearance and 
magnitude of the areola, its continuance may also be men- 
tioned, as differing in different persons. It mostly however 
begins to recede about the twelfth or thirteenth days; com- 
mencing frequently from the centre, and gradually advan- 
cing to the circumference, so as to leave a ring of inflamma- 
tion at some distance round the pustule. The declension of 
the areola is nearly as rapid as its progress, leaving the skin 
for a short time of a dingy hue ; at least I have repeatedly- 
seen it.J -A desquamation of the cuticle to the extent of 
the areola generally follows. 

The change of colour which takes place in the centre of 
the pustule about the close of the tenth day, in consequence 
of the contained fluid beginning to dry away, indicates the 
commencement of tbe process of scabbing, which is mostly 
complete in two or three days ; that is to say, a darkish hue 
has by this time extended over its surface. The pock gra- 
dually hardens, becoming of a dark brown, mahogany, or 
chesnut colour, exhibiting a fine polish and of the same cir- 
cular, or oval, appearance with the pustule. In about ten 
days or two weeks, if it is not previously rubbed off, the fluid 
below having been totally absorbed, the scab begins to sepa- 
rate at its circumference from the surrounding skin ; it then 
soon falls off, leaving the skin below perfectly sound, though 
mostly with a depression or pit. In some cases the scab falls 
off before the fluid is perfectly absorbed, leaving consequent- 
ly, a surface not completely healed, on which a second and 



•f* This itching frequently continues troublesome although lead 
water or other cooling applications be employed. I have lately recei- 
ved a letter from England, in which I am informed, bathing the in- 
flamed part with rectified spirit of wine, or ardent spirits, has suc- 
ceeded immediately in removing it. I have not yet tried its efficacy. 

% Sometimes the areola declines in such a manner as to leave an 
external ring of inflammation, and an internal one adjoining thepus- 
ele. (See the plate, twelfth day.) 



41 

sometimes even a third and fourth scab successively form, 
without any inconvenience or uneasiness. 

It sometimes happens, as I have before stated to have 
been the case with myself, that the scab forms at a much 
earlier period, even so soon as the seventh and eighth days: 
it falls off proportionably early. In other cases no disposi- 
tion to form a scab exists as late as the fifteenth, sixteenth, 
and seventeenth days; even though the areola had commen- 
ced at the usual period, and continued not longer than is 
common. In the case I several times have adverted to (case 
26) from which I obtained matter on the fifteenth day, the 
areola appeared on the thirteenth, but less regular than usual, 
on the fourteenth day the patient exerted himself very con- 
siderably at a fire in handing buckets, after which a red 
Bof the size of his finger was very conspicuous, run- 
rom the pustule to the axilla (doubtless exhibiting the 
of a lymphatic), but not accompanied with any pain: 
fifteenth the areola was nearly gone, but there was no 
ance of a scab. The pustule all this time was increas- 
ing, being at this period very nearly half an inch in diame- 
ter. On the sixteenth a scab commenced, which did not 
come off till the fifth week from vaccination, and then left a 
second scab beiow: I might have procured matter two or 
three days I believe longer than I did, but I was fearful of 
inducing a spurious disease.* In another case the areola 
commenced about the eleventh day, continuing the twelfth, 
thirteenth, and fourteenth, during all which time the pus- 

* With this matter I vaccinated at the same time two children, in 
one of whom the scab did not form till the fifteenth or sixteenth day, 
when the pock was nearly half an inch in diameter. In the other the 
scab progressed at the usual time (see case 33, 34.) All these facts 
convince me that perfectly limpid matter from a perfect pustule may 
at any time be taken before the scabbing commences. I do not how- 
ever mean to recommend it. One thing is remarkable in the above 
cases 5 that the matter failed in both, in the first attempt, when it was 
eight days old, but succeeded in the second attempt five days later. 

[ 6 ] 



tule increased considerably, and continued so to do till the 
seventeenth day, when it was more than one-third of an inch 
in diameter; it now began to scab, and rapidly increased. 
In this case I tried to obtain matter from the pustule previ- 
ous to the commencement of the areola, but it was scarcely 
enough to moisten the point of my lancet, though the pus- 
tule was as beautiful as I have seen. 1 did not try after the 
areola commenced; but I apprehend I might have secured 
some on the fifteenth and sixteenth days. 

These appear to be the varieties of the regular disease; 
I must not however omit to mention that I have met with 
several cases, in which from five or six, to twenty or thir- 
ty small pimples arose in the vicinity of the vaccinated 
part, continuing for about three days, and then gradually 
declining without filling with any, fluid. I considered them 
as arising from local irritation. It is mentioned by Ring 
and others as occasionally occurring. J Whether they ever 
fill, and assume a Vaccine appearance I know not, but ra- 
ther imagine this to be the case; in case 34, on the ninth 
day several little pimples broke out about the vaccinated 
part and above it. By the twelfth day they all had disap- 
peared but three, of which one assumed the true Vaccine 
character ; from it I transferred the disease to another per- 
son. It is to be noticed that these secondary pustules ad- 
vance rapidly to their acme, and as rapidly decline. The 
above-mentioned pustule had a scab nearly complete by the 
termination of the fifth day. Although the Vaccine erup- 
tion, independently of the local pock, is a very rare occur- 
rence, yet sufficient proof exists that such an eruption occa- 
sionally takes place. The above case is in point. The child 
vaccinated from it, had also a true Vaccine pock on the right 
thigh. These are the only cases I have seen; but President 
Jefferson in his letter to Mr. John Vaughan mentions two 
or three of about two hundred cases, who had from two to 

% These are the same kind I apprehend which are mentioned by Dr. 
jenner (seep. 13), and which are represented in the plate on the 
tenth day. 



43 

half a dozen pustules on the inoculated arm only.* The 
Rev'd. Mr. Holt I have mentioned above as giving two ex- 
traordinary cases of above one hundred pustules each, (see 
p. 33.) As for the pustules which appeared in London at 
the first introduction of the disease, little doubt is now en- 
tertained of their having been variolous. Dr. Woodville is 
I believe entirely of this opinion at present. It does not 
appear, that the infection of the true Vaccine pustulous cases 
is more disposed to produce a violent disease than if taken 
from the local pustule. 

In two or three instances in infants, about the sixteenth 
day, I have noticed a few minute pimples or specks on the 
face and neck, resembling flea-bites which gradually disap- 
peared ; whether they were any way connected with the Vac- 
•cine I cannot say. I have seen also about the same period 
a nearly similar eruption, but more numerous upon the head 
of an infant of two months old, which appeared to be attend- 
ed with considerable itching : it declined however in a few 
days. I do not think these were any more than accidental 
concomitants of the disease. I have seen a similar eruption 
on the twenty-first day, and on the fifteenth, in two chil- 
dren vaccinated on the same day and with the same matter. 
An eruption on different parts of the body, as a scarlet efflo- 
rescence, has also been mentioned by some authors. I have 
never seen it. 

Having thus given as concise a view of the origin, as also 
of the general appearance, the progress and the varieties of 
this extraordinary disease, which have come under my own 
notice, as was in my power. I shall say a few words on 
the medical treatment. 

" Much of the hazard incurred in the small-pox is owing 
to a larger eruption upon the skin than the constitution can 
support," as Mr. Aikin has justly remarked. This howe- 
ver is not the only source of danger. The febrile symptoms, 

* Probably these might be only pimples of the nature abovemen- 
doned ; I have not learnt if any came to maturity. 



44 

even when scarcely followed by a dozen pustules, are often 
accompanied by convulsions of the most alarming nature. 
Neither has the small-pox been rendered so perfectly safe 
by inoculation as some pretend to assert, as to enable us to 
insure its successful termination. Those Physicians there- 
fore, who oppose the Vaccine under the plea of the absolute 
safety of inoculation, must either be totally ignorant of the 
disease they profess to understand, or wilfully blind to the 
hazard incurred, from the narrow principle of self-interest. 
I shall however attempt to prove to the satisfaction of even 
these narrow-minded Practitioners, that it is as much their 
interest as their duty, to employ this, the mildest of diseases, 
in preference to one of the most destructive maladies of the 
human race. It has been estimated that one person in two 
hundred dies of the inoculated small-pox, and this is perhaps 
not much out of the wav on a large scale. Now if we 
consider the total inhabitants of this globe as amounting to 
a thousand million, we may calculate that the one-fiftieth 
part die annually, and a like number receive existence. Of 
this fiftieth part or twenty millions (supposing the whole 
number were to be inoculated for the small-pox) the above 
calculation of one-two-hundredth part falling a sacrifice 
to its fury, will yield a total annual mortality of one hun- 
dred thousand persons. When however we view the rava- 
ges of the Natural Small-pox, especially in the vast regions 
of Africa where medical advice is scarcely known, it would 
be found that not less than one in ten (many calculate one 
in six to die with the natural small-pox) or two million an- 
nually, fall victims to this dreadful disease. As this calcu- 
lation is onlv made on a supposition of a perfect regularity 
in the premises laid down, 1 shall take surer ground, by 
stating from the authority of Dr. Lettsom, that two hun- 
dred and ten thousand persons annually die of the Small-pox 
in Europe alone. And Dr. Herman Mc. Donald asserts that 
it proves fatal to forty millions in everv century. In France 
it is calculated that one in fourteen dies of the small-pox. 
The total number of deaths in a year is estimated at nine 



45 

hundred thousand on an average, of which upwards of six- 
ty-four thousand are of the small-pox. 

Dr. Moreau informs us sixteen thousand persons died of 
the small-pox at Naples in one year, and twenty thousand 
at Paris in another. In England thirty thousand perhaps are 
(were) carried off annually by the small-pox. How grateful 
to the feelings of the illustrious discoverer of the efficacy 
of Vaccination must die reflection prove, that to him will 
mankind owe the preservation of so many lives ! 

These strong and demonstrable truths must I think carry 
conviction to every mind, that great indeed is the moral 
obligation of Parents and Physicians, to save this immense 
population to the world, bv the general introduction of the 
Vaccine ; a disease, which most assuredly, has never of 
itself proved fatal to a single person. What must be the 
feelings of a parent who with these facts before him, (not 
founded on the assertion of an individual, but confirmed by 
the testimony of thousands of witnesses, the most respecta- 
ble for their talents and situation), what I ask must be his 
feelings, when he sees a beloved infant writhing under the 
tortures of this foe to mankind, without having even given 
him a chance to escape by shielding him with this " asgis 
of Jenner ?" If a parent's feelings can thus be wounded 
by self conviction; how much more intensely should that 
Physician suffer, who, duly impressed w T ith' the certainty 
of the preserving influence of the Vaccine, should lose a 
patient by inoculation ! For my own part, I freely own, 
that with my present views on this subject, I should feel 
myself accessary to the death of the patient | and nothing 
but inability to procure the Vaccine infection, w T ould ever 
now induce me to recur to variolous infection, antecedent 
to Vaccination, in which case I should regard it as the less 
of two evils.* 

* I may perhaps add another exception to this general determination. 
I mean the inability by repeated attempts to produce the Vaccine. See 
case 30, whom I vaccinated fourteen times ineffectually, previously to 
any attempt to inoculate. He has resisted one attempt to excite the 
Small-pox, 



4 6 

It appears to me most extraordinary, that every parent 
does not anxiously seize the opportunity of giving their 
helpless offspring a chance to escape the ravages of the 
Small pox. The simple act of substituting the minutest 
speck of Vaccine or Variolous infection, may prove the 
means of future happiness, or a source of hitter reflection, 
and too late repentance. If beauty in a female is desira- 
ble in the eyes of a parent, how much reflection is nrcessary 
before those pleasing prospects are blighted by the Small-pox ! 
Even were it proved the Vaccine was not the preservative 
it is, what ill is to be apprehended from a disease, so slight 
as to exceed the range of possibility, to suppose, that death 
could be induced by it ? 

How eccentric is the conduct of mankind ! With testimo- 
ny in favor of the Vaccine ten thousand times stronger 
than would be required by the most prejudiced person, to 
convict an individual in a court of justice, is it not surpri- 
sing the slightest objection can be advanced against it ? 
Can we be surprised at the disbelief evinced by many in 
the Holy Scriptures, though so strongly attested ; when we 
see this propensity to scepticism so prevalent on a subject, 
the truth of which every one has it in his immediate 
power to verify, and which appears to stand on a founda- 
tion as strong as Christianity itself? 

What shall we say of the conduct of those Physicians, 
who, without any endeavour to investigate the truth of the 
doctrines advanced respecting the Vaccine, arrogantly as- 
sume to themselves the privilege of denying its merits alto- 
gether, or else assume as a fact that its prophelactic pro- 
perties do not exceed the limits of a few years ? Such Phy- 
sicians there are, (if they deserve the title) and not many 
miles from this metropolis, who thus strive to check the 
progress of this invaluable blessing. If they wilfully re- 
ject the firm basis on which it stands, they certainly de- 
serve the detestation of mankind : if it arises from igno- 
ranee, we must pity the fate of such, as trust their 
lives in the hands of those, who will not take the 



47 

trouble to render themselves acquainted with the facts they 
thus presume to oppose. 

That it is the interest of Physicians to employ this in 
preference to the small-pox, will I hope be rendered evi- 
dent when I come to consider the difficulty of procuring 
and preserving the infection. On those two points I rest 
the argument ; because I am well satisfied none but Physi- 
cians will take the necessary trouble to effect these ends, 
or with but few exceptions. Those who are objects of 
charity must still continue such, whether the Vaccine or 
the Small-pox are employed ; and those who can afford to 
recompense a Physician for his labour, will scarcely take 
the disease into their own hands, merely to save a trifling 
expence.* 

But to return from this digression. It may readily be 
imagined, that a disease so mild as the Vaccine, very rarely 
requires the aid of medicine, indeed I might say, never, as 
far as it respects the mere disease. Perhaps nineteen of ' 
twenty scarcely exhibit a perceptible indisposition: during 
the period of dentition, or in slight complaints of the 
bowels, I have in several instances had reason to suppose 
the febrile symptoms were not increased by the accession 
of the Vaccine. In adults, they are occasionally more con- 
siderable ; but even they, suffer but little uneasiness which 
a dose of cooling physic is not capable of removing. 

Dr. Jenner says [p. 98) " from the very slight indispo- 
sition which ensues incases of inoculation, where the pus- 
tule, after affecting the constitution, quickly runs into a 
scab spontaneously, or is artificially suppressed by some pro- 
per application, I am induced to believe, that the violence 
of the symptoms may be ascribed to the inflammation and 
irritation of the ulcers (when ulceration takes place to any 

f The danger of producing a spurious disease in place of the ge- 
nuine pustule, should also have its due weight with thos^e who are 
disposed to take the disease into their own hands. 



48. 

extent, as in the Casual Cow-pox), and that the constitu- 
tional symptoms which appear during the presence of the 
sore, while it assumes the character of a pustule only, are 
felt but in a very trifling degree." At (p. 103) he adds 
" that the most material indisposition, or at least that which 
is felt most sensibly, does not arise primarily from the 
•first action of the Virus on the constitution, hut it often 
comes on, if the pustule is left to chance, as a secondary 
disease" He further adds (p. 109) " As the cases of ino- 
culation multiply, I am more and more convinced of the 
extreme mildness of the symptoms arising merely from 
the primary action of the virus on the constitution, and 
that those symptoms which (as in the accidental Cow-pox) 
affect the patient with severity, are entirely secondary, ex- 
cited by the ♦irritating processes of inflammation and ulce- 
ration." I am happy to have the authority of this cele- 
brated character on this important point ; and as far as my 
•experience goes, I most unequivocally coincide in the above 
remarks. All the cases which have proved any way dis- 
agreeable, have been those, where from inattention the 
scabs have been rubbed off and ulceration produced. And 
this leasts me to say a few words on this head, as it regards 
the symptoms and medical treatment. 

It has been observed that in a majority of cases, the pro- 
cess of scabbing follows vesication with the most perfect 
regularity. In these cases little indisposition is perceptible ; 
but when from inattention or from any other source, the 
scab is either rubbed off, or the pock is much irritated ; vio- 
lent inflammation sometimes follows, accompanied with 
considerable tumefaction, extending to a greater or less dis- 
tance, sometimes even up to the shoulder and down to the 
wrist; great pain of the part vaccinated, shooting up to 
the axilla; to which succeed inflammation and swelling of 
the axillary glands, chills, fever, restlessness, anxiety, nau- 
sea, vomiting, head-ach and pain of the back. These 
symptoms in part, or successively, increasing, usually sub- 
side in a few days of themselves, though now and then a 



49 

case of greater violence will protract itself one, two, and 
even three weeks. It is however uncommon to find it 
so violent as not speedily to yield to a gentle antiphlogistic 
treatment, in which may be included due attention to the 
local complaint, which by this time has probably put on 
the state of a disagreable phagedenic ulcer ; sometimes 
with a luxuriant growth of flesh, shooting up nearly one- 
third of an inch above the surrounding skin, and very ten- 
der to the touch. The axillary glands I have seen swelled 
nearly as large as a pigeon's egg, and accompanied with an 
erysipelatous inflammation over the whole limb ; the ulcer 
at the same time pouring out a considerable quantity of a 
limpid fluid for the most part, but occasionally of a puru- 
lent nature : When the disease has got to such a height, 
(which it seems incapable of doing without a successive 
series of negligence and topical injury), it requires some 
active application to arrest its progress. In three or four 
cases which have come under my notice, I have found no- 
thing equal to the unguentum citrinum. The mercurial 
and the red precipitate ointments are much recommended. 
In milder cases lead water, or Goulard's extract, will ge- 
nerally prove effectual. When the inflammation and pain 
are very great, it is necessary sometimes to poultice the 
sore ; in one instance a poultice of the marsh mallow, ap- 
plied without my advice, seemed to give more relief than 
the usual bread and milk poultice. It is seldom I believe, 
that the above mentioned ointments applied night and 
morning to the surface of the sore only, % will not cause 
it to assume a healthy state in a few days ; lead water or 
merely cold water to the inflamed limb may be applied at 
the same time with advantage. Some smart purgative eve- 
ry day or two, and abstaining from animal food and liquors, 

* I saw one case in which the unguentum citrinum, applied incau- 
tiously over the surrounding inflamed skin, seemed to destroy it, and 
thereby augmented the sore. When applied solely to the ulcer its ef- 
fects were very advaiatageous. 
[ 7 ] 



So 

will generally produce a cure in a short time, or so dispose 
it to heal, that any common dressing will suffice. 

I have been much surprised to see the small cicatrix 
which has remained after such a disagreeable ulceration ; 
indeed it would seem as if it was incapable of exerting so 
much violence on the skin and cellular membrane as the 
Small-pox; although its appearance in such violent cases is 
1 think nearly as alarming as that arising from the Small- 
pox. I form this opinion from the case of a mulatto wo- 
man who came under my care, and whom I vaccinated in 
two places of the fore-arm (case 25) ; the infection took 
effect, and by the fifth day, the punctures were raised into 
two purulent looking pustules, not of the regular Vaccine 
form. As I had not a doubt of the spurious nature of the 
disease, I repeated the Vaccination on the same arm at 
about two inches distance from the former. This attempt 
produced one of the most beautiful pustules I have seen, 
and little indisposition attended. About the cessation of 
the attending symptoms, notwithstanding my strictest cau- 
tion, I found her nursing a child, and otherwise using her 
arm, by which the true Vaccine pustule was rubbed ofF, 
and the crustaceous scabs of the spurious ones also. From 
this moment the symptoms increased; and ran to the extent 
I have above enumerated. The arm was swelled most 
enormously, and the pain and enlargement of the axillary 
glands was very alarming. The steady application of the 
citrine ointment, and one or two strong mercurial purges, 
soon relieved the most urgent symptoms ; and though the 
sores had extended themselves to above three-fourths of an 
inch, yet in less than a week they were reduced nearly one 
half, and the whole was perfectly well in about six weeks 
from the first Vaccination. In another instance, a child of 
two years of age, the pock which progressed in the most 
favorable manner, was unfortunately rubbed considerably 
on the seventh day, and this was repeatedly the case till 
the tenth and eleventh days, when the indisposition, till 
now trifling, became very serious : the inflammation and 



5* 

swelling increased rapidly, and the pain was very severe. 
In this case it was that the axillary glands became nearlv as 
large as a pigeon's egg. The sore looked very ugly, and 
required constantly to be poulticed for several days, during 
which it was with difficulty I could persuade the mother 
to force down a dose of physic. It soon began to assume 
a better appearance, and by the end of the fourth week 
was nearly covered with a hard dark coloured scab. J 
must observe that this child was of a very gross habit of 
body, and much troubled with worms. Being anxious to 
see the regular progress of the disease, I did not restrict 
the child in his diet during this period. The weather was 
at the same time very variable, cold and wet,* and the 
child always out in the street. These circumstances will 
tend in some degree to account for the violence of the 
symptoms. 

Where proper precautions are adhered to, I believe but 
few instances of such violence would take place : indeed if 
the sore is taken immediately in hand, lead water would in 
nine cases of ten prove sufficient to check the further pro- 
gress. If the inflammation after the twelfth day should 
continue, lead water seems all that is required, and not 
even then, unless it should seem to increase ; for till that 
period, it is only progressing as it ought. 

It has been proposed by some, after this period, to check 
any further disposition in the pock to spread, by applying some 
active corrosive substance for a few seconds, by which cica- 
trization is forwarded and danger of ulceration is prevented. 
The sulphuric acid on the head of a probe is recommended 
to be held a few seconds to the pock and then washed off. 
Of its efficacy I cannot speak, as I have not tried it ; being 
more desirous of seeing the natural progress of the disease 



* Upon referring to the other cases which have proved troublesome, 
I find they all took place in the same state of the weather. And it has 
been observed in England that a cold N. E. wind produced an aggra- 
vation of the inflammation. 



5* 

than to check it. Mr. Aiken has given a judicious caution 
against its premature use, lest it should entirely extin- 
guish the disease, before the constitution is rendered secure 
against the Variolous infection. 

In the above mentioned cases the cicatrices were very- 
small compared with the apparent ulceration. I must add, 
that nothing like convulsions appeared in any instance, al- 
though the symptoms ran so high. How different from 
the Small-pox ! I may indeed ask in what do they agree % 
I think I may say in nothing ! Whatever proves bad in the 
Vaccine, is not essential to, but an accidental concomitant 
of the disease; whilst what is good is exclusively its own. 
On the contrary, the Small-pox is bad from beginning to 
end, without a single admixture of good to recommend 
it ; and not unfrequently leaving a remembrance of itself to 
the termination of life. 

I cannot refrain from adding the character of the Vaccine, 
as drawn by the enthusiastic but masterly hand of Mr. Ring. 
" As to the genuine disease, if disease it can be called, on 
the third day it resembles a flea-bite ; on the sixth a crystal ; 
on the tenth a pearl ; on the twelfth a rose ;- — a rose without 
a thorn ! 

" The vesicle which it displavs, may be considered as a 
gem of inestimable value ; and the fluid which it contains, 
a precious balm. How enviable is the lot of that man, 
who has put the world in possession of such a treasure ! It 
is to himself an inexhaustible source of happiness ; and to 
the land which gave him birth an eternal monument of 
glory." See p. 743, 

As the preservation of this matter is of the highest im- 
portance to mankind, it is incumbent on every Physician to 
pay the strictest attention to this point, more especially 
those who live in the country, where a failure might be 
with difficulty supplied. Disappointments will often occur, 
even when every precaution is taken to insure success. 
Matter will frequently fail, though employed immediately 
after being taken from a pustule, at the earliest period : 



S3 

this I apprehend must depend in a great measure on an in- 
disposition to receive the impression of the disease; we 
see the same in the Small-pox ; and the same diversity ex- 
ists in different persons, and in the same person at different 
times, with respect to the application of medicines. 

This torpor, or whatever it may be, is unaccountable per* 
haps, though the fact is certain. I have in a former part 
mentioned a few remarkable instances of this kind. 

Though the Vaccine infection fails perhaps more fre- 
quently in a first attempt than the Variolous, I do not so 
clearly perceive that it is more perishable. What would be 
the greatest period of time at which Small-pox matter would 
succeed, I do not exactly know. The Vaccine has proved 
effectual at the end of three months according to Dr. Jen- 
ner ; and Dr. Marshall succeeded with it after as long a pe- 
riod. I received a portion from England which proved suc- 
cessful, though it must have been nearly three months old. 
These circumstances appear favourable, but I suspect it 
would not often be the case without the greatest precauti- 
on.* Four portions of matter which I received from Eng- 
land, failed in taking effect though put up with the minu- 
test care. Matter which has been taken but a very short 
time, (not above a day or two) has failed in the hands of 
Practitioners to whom it was sent at but a few miles distance 
from town. Other portions have proved successful which, 
have been sent off under similar circumstances. When it 
is to be immediately employed, perhaps the lancet is the best 
mode of conveyance ; though 1 am not so satisfied on this 
head as I was, because the matter is very insoluble, and I 
apprehend is seldom so thoroughly dissolved, as when uni- 
ted with water by a lancet point on a piece of glass. If it 
is taken on a lancet, it is improper to allow it to remain more 
than a very few days, because it very soon rusts the iron. 

* By referring to case 47 in the tables, it will be seen that I had 
some reason to believe I succeeded in exciting the Vaccine with infec- 
tion almost four months old, which I had paid no particular attention 
to preserve from the air. 



54 

The method 1 have employed to preserve the infection 
has chiefly been on thread and glass. I have taken it on 
thread mostly for the purpose of sending to Practitioners at 
a distance from the city. I have generally inclosed the thread 
in a piece of paper, and surrounded it with gold-beater's skin, 
so as to transmit it readily in a letter by the post; or I have 
thrust the paper into a quill, and after stopping it with a 
cork, have surrounded this with gold-beater's skin. In a 
few instances I have sent the matter on a piece of glass, 
which I have fitted with a piece of talc or isinglass, and 
coated with gold-beater's skin ; and again I have put the 
impregnated thread between two plates of isinglass and 
coated it as before. All these several ways have I believe 
succeeded. 

For my own use, I preserve it between two plates of 
glass which I coat as above ; and I have always taken the 
precaution to note down on a piece of paper with which I 
surround them, the name of the patient, together with the 
<lay of the disease, and that of the month, by which means 
I am able to trace up the disease to its primary source : I 
have never omitted when it was in my power, to procure 
the first portion of matter, and thus secure it for my future 
use; after which, I have procured it for others. 

An ingenious mode, which is pursued by a Practitioner of 
this city, is by applying to the punctured pustule, a capillary 
tube ; by exhausting the air with his lips, the fluid which ex- 
udes is forced up into the tube. This is then stopt with wax, 
or some other substance. To vaccinate with this, after ma- 
king one or more punctures on the arm, the end of the tube 
-is applied, and a fine wire pushed down, which carries the 
-limpiu infection before it and deposits it on the punctured 
park By this mode of preservation, evaporation is entirely 
prevented, and the infection continues fluid, How long 
this may be the case I know not. I apprehend however 
some danger is incurred of the putrefactive process com- 
mencing in the tube, in consequence of the atmospheric 
air contained. This, though small in quantity, is large in 



55 

comparison to the portion of infection which has been 
drawn up, I know of no mode by which a vacuum is to 
be maintained there. Messrs. Ballhorn and Stroineyer* 
have proposed the vacuum of a barometer to secure the in- 
fection on thread. Time will shew if the above objections 
are well founded. I have not yet pursued the plan, but think 
it deserves attention. 

The most certain method of transmitting the infection to 
a distance is doubtless by a patient having the disease upon 
him; the sources of failure however are so numerous, that 
it behoves every Practitioner to attend most closely to its 
preservation whenever he has obtained it. I think it of 
sufficient importance to specify the various sources of fai- 
lure of infection in this disease, which at present occur to 
me. 

First. It arises from the inattention of Physicians them- 
selves, in not securing the matter when once it is in their pos- 
session, but depending for a future supply from their more 
attentive neighbours ; this is an evil which I hope will cure 
itself; as I think Physicians will soon discover their error in 
depending upon others for a supply. 

Second. It? fails from the mode of preserving it, as on 
the point of a lancet, if not employed in a few days. 

Third. With every disposition to secure it, it fails be- 
cause a Physician cannot always insure a.succession of pa- 
tients ; in consequence of which the matter loses its effica- 
cy before it is again employed. 

Fourth. It fails from the premature destruction of the 
pustule, by being rubbed off. 

Fifth. Sometimes with the most favourable appearance, 
the pock will yield little, if any infection. 

Sixth. From the mildness of the disease, we can never 
insure finding the patient in the way at the proper period for 
taking it. 



* Trails de V inoculation de la Vaccine, p. 79. 



56 

Seventh. It happens that from an Indisposition to receive 
the disease ; really active matter will produce no effect in 
one person, though in another it will succeed. § 

Eighth. It may be taken at too late a period of the di- 
sease. 

Ninth. Drying with too considerable a degree of heat, 
as by the fire, which destroys its activity. 

Tenth. The true Vaccine will sometimes produce a spu- 
rious disease in one person, though it would not in another, 
(Case 1. Note). 

Eleventh. A rough and unskilful mode 01 performing 
this apparently trifling operation^ by exciting considerable 
inflammation, may destroy the disposition to receive the im- 
pression of the disease, and hence prove a source of failure. 

Twelfth. The last and most extraordinary source of 
failure is, that which arises from parents not permitting 
the matter to be taken from their children. That such 
an occurrence should take place is wonderful, when it 
is considered that only one pock in general is produced ! 
This it must be allowed is a most impolitic plan. How can 
a parent expect to be supplied with infection, when he re- 
fuses it to others ! It is not in this disease as in the Small- 
pox, which preserves itself by its contagious narure, or 
which often produces such abundant crops as are sufficient 
to inoculate a whole town. I do not think a person who 
thus refuses to extend the benefits of this disease, ought 
ever to partake of them ; but should be doomed to suffer 
under the severity of the Small-pox. Nor could he com- 
plain; because he is aiding this insidious disease, by not op- 
posing it; or at least by shutting up the means of oppositi- 
on in his power. 

§ We even see this in the same person, when of two or three punc- 
tures, made precisely in the same way and with the same care, only 
one will take effect. The same matter also, will with similar pre- 
cautions fail in the same persons, in one attempt, which will succeed 
at a later period. See cases 33, 34. 



57 

Many persons suppose that taking the matter is productive 
of a sore arm. This is not the case as hundreds can testi- 
fy. Nay more, it appears when done cautiously to house- 
ful, by taking away that matter sooner, which must other- 
wise be absorbed in a more tedious way. The few cases 
of sore arms I have met with, have been where I have 
taken the matter but once or twice j and I have I believe 
in nearly a dozen cases, obtained it from four to eight days 
successively without detriment. I hope these observations 
may prevent the frequent occurrence of an evil of such mag- 
nitude to the community. It may easily be supposed, that 
what happens to one person, might to another; and it is 
only extending the refusal to every Practitioner, and how 
soon should we have to lament the loss of this invaluable 
blessing ! 

It is from the above considerations, that I have anxiously 
endeavoured to establish an institution for the Vaccine ino- 
culation. Hitherto I have failed. Many have supposed 
it may be preserved by the charitable institutions already 
existing. Little difficulty it is true has yet occurred : by 
considerable pains I was enabled to preserve the infection 
till the period of inoculation was approaching ; by which 
time it had extended its influence among my fellow Prac- 
titioners : many were anxious to participate in the blessing, 
and the disease consequently kept its ground. But now 
the season for inoculation declines, the infection may not 
so readily be procured, from its being out of the power of 
Physicians to insure a constant succession of patients;* and 
if even one or two could do so, it can scarcely be supposed 
they will occupy their time in securing matter for those, 
who by inattention and neglect have lost it to themselves. 

* Although Vaccination may suffer a temporary decline during the 
warm weather, yet every season is nearly equally proper; and no 
doubt the period will soon arrive, when such will be the confidence 
placed in the mildness and efficacy of the disease, that no particular 
time of the year will be considered as preferable to another. 



1 must lament the want of such an institution, which is 
established in almost every city of note in Europe ; and which 
example New- York and Baltimore* have wisely followed, 
I anticipate the establishment of one here, when the diffi- 
culty of preserving the infection, pure and permanent, 
shall evince its propriety. 

The great difficulty of procuring and preserving the in- 
fection, is the argument I proposed to'advance, as proof of 
its being the interest of Physicians to employ the Vaccine ; 
for it is incredible that it can ever be long in any hands 
but those of the medical profession, as none but Physici- 
ans, and but few of them I fear, will- take the neccessary 
trouble to preserve it*. Hence I think those persons are 
in a great error, who consider the introduction of the Vac- 
cine in opposition to the Small-pox as inimical to their in- 
terests. Were this even the case it is of small weight in 
the balance of humanity. 

With respect to the best method of Vaccinating I shall 
say but little. The mode I have almost invariably pursued 
has been by puncture ; which mode, from the less degree 
of injury? I apprehend, is more likely to induce the genuine 
disease in all its native elegance, than when an extraneous 
body, such as thread, is suffered to be retained, and con- 
sequently to produce occasionally, local irritation not con- 
nected with the Vaccine ; of this however I am not posi- 
tive, for some of the most beautiful pock I have seen have 
been excited by means of thread. 

• When 1 have not employed the fluid infection, I have 
generally moistened the dry matter on glass. This requires 
much care, owing to its difficult solubility. With a lan- 
cet thus armed, I gently raise the cuticle from the skin 
beneath, forming a small triangular pouch, into which I 
introdudl the infection, which thus lays as it were com- 

* How can it be properly ascertained also, by any but those who 
are conversant with the disease, whether they produce a spurious or 
genuine pustule ? 



59 

pletely enveloped. It is by no means requisite to draw any 
blood in the operation. On the contrary, where the sys- 
tem is disposed to receive the impression, the less the inju- 
ry to the tender extremities of the absorbents, the better. 
In a few instances it has progressed most delightfully, 
though at the time of Vaccination I was altogether unable 
to distinguish the puncture I had made; hence I have, oc- 
casionally, from a desire to introduce more of the infection, 
produced, by unintentionally wounding the cuticle in ano- 
ther part, two pustules. This shews the facility of indu- 
cing the disease in some instances, in contradistinction to 
those difficult cases I have before noticed. 

To dilute the infection I have constantly employed cold 
water ; not that I consider it more proper than warm wa- 
ter, as some do, who view the matter in so volatile a light; 
but the idea of using warm water appears to me absurd, 
when we consider the quantity taken upon the point of the 
lancet is so small, that it must have acquired the tempera- 
ture of the atmosphere almost before it is brought into con- 
tact with the infection it is intended to dilute ; and certain- 
ly long before it is inserted into the arm. Whether warm 
water was originally employed to give a greater air of mys- 
tery to this simple operation, I know not; I am however 
perfectly satisfied it is altogether unnecessary. 

I have said above, that it is unnecessary to draw blood : 
i may however add, that a small quantity will not prevent 
the action of the infection. 

As this disease is comparatively new in this extensive por- 
tion of the globe, it will certainly not be deemed improper 
in this place to take a short view of some of the most im- 
portant facts, which substantiate its prophylactic powers 
against the Small-pox, in order to combat the opposition it 
may experience from ignorance or intentional misrepresent- 
ation ; as well as to remove the fears, which have unfertile 
nately been excited against it, by the introduction of a spu- 



' Go 

rious disease in several parts of America ; which fears have 
as yet by no means subsided.* 

To accomplish this end, 1 shall notice in the first place 
the testimonial in its favor which was brought forward in 
London, and signed by more than fifty Physicians, and dou- 
ble that number of Surgeons, gentlemen of the highest re- 
putation in the profession. This example was followed in 
various parts of England with the greatest advantage • and 
such a testimonial should also be signed by the Physicians of 
America, who know the value of the Vaccine, in order more 
speedily to diffuse it. The following is the testimonial. 

" Many unfounded reports having been circulated, which 
have a tendency to prejudice the public against the inocula- 
tion of the Cow-pox; we, the undersigned Physicians and 
Surgeons, think it our duty to declare our opinion, that those 
persons who have had the Cow-pox, are perfectlv secure 
from the future infection of the Small-pox. 

" We also declare, that the inoculated Cow-pox is a 
much milder and safer disease, than the inoculated Small- 
pox. " 

To render this testimony more strong it may be observed, 
that several of the gentlemen who have thus given it their 
decided support, were in the first instance strongly opposed 
to the disease : As it may be reasonably presumed they did 
not change their sentiments without the most perfect con- 
viction, this testimony is certainly of the strongest kind. 

The Rev'd. Mr. Jenner related to Mr. Ring (p. 606), 
that he had vaccinated about three thousand persons. " At 
Burbage in Wiltshire, where he had inoculated (vaccinated) 
about half the inhabitants of the parish, the small-pox since 
raged, and swept away a number of persons ; but all those who 
had been inoculated by Mr. Jenner escaped, as if sacred from 
the ravages of that destructive pestilence." To this " se- 

* This part of the subject is earnestly recommended to the atten- 
tive consideration of those whose minds are yet undetermined respect- 
ing the merits of the Vaccine, whether they be Parents or Physicians. 



6i 

vere test" of the efficacy of the disease, as Mr. Ring calls 
it, I shall add the following letter from Dr. Farquhar to me, 
in answer to an enquiry I made upon the subject, and which 
with his permission, 1 ma.de public at the time, in hopes of 
exciting the confidence of the public in the Vaccine. 

" Philadelphia, Dec. 16th, 1801. 
" SIR, 

« WHOEVER makes the investigation of 
medical science the object of his pursuit, and its application 
for the benefit of mankind the end of his wishes, is cer- 
tainly entitled to the gratitude of his fellow-citizens. The 
advantages of Cow-pox over the Variolous disease having 
been so fully proved, your exertions for its introduction here, 
are highly laudable. In reply to your, enquiries respecting 
Vaccination in Jamaica, I beg to inform you, that matter 
having been about eight months ago procured from Eng- 
land, inoculation immediately took place ; since which pe- 
riod many thousand persons have undergone the disease. Of 
this number about twelve hundred were inoculated in the 
parish of Trelawny, who (excepting about thirty ', in whom 
after repeated inoculation no symptoms of disease occurred) 
had the complaint so mild, that during its continuance they 
were enabled to follow their usual avocations. Of the thir- 
ty before alluded to, upon being inoculated with Variolous 
matter, fifteen had the Small-pox ; but although, in order 
to ascertain the truth of the Vaccine proving a certain ex- 
emption from the Variolous disease, every person, who had 
been previously inoculated for Cow r -pox, afterwards un- 
derwent the same operation with Variolous matter, in no 
one instance did the disease follow, when the presence of 
Cow-pox had been previously correctly ascertained. Among 
the advantages of the Vaccine disease over Small-pox, are, 
its never having in any one case terminated fatally ; its 
requiring no previous preparation of either regimen or me- 
dicine; its being attended with so slight indisposition as 



6z 

scarcely to constitute a disease ; its being produced by ino- 
culation only, and consequently never contagious, it dif- 
fers from Small-pox also in this, that a person may have 
the complaint more than once; it however sympathizes with 
Small-pox so far, that when a Variolous atmosphere pre- 
vails, its [symptoms are considerably more severe; and its 
proving a certain exemption to that disease is now so fully 
proved, that it has ceased in Europe to be doubted. Inno- 
vations in medicine have ever met with opposition ; it is not 
then to be wondered, that there are those who have with- 
held their sanction from the introduction of Cow-pox: Its 
advantages are now, however, so well established, that we 
may reasonably hope Small-pox in a few years will be known 
only by name. Indeed, when we reflect that under all the 
advantages of art the Variolous disease sometimes termi- 
nates fatally, and that of many hundred thousand cases of 
Cow-pox in Europe, no one person has ever been known to 
die, we cannot but consider Vaccination as one of the most 
beneficial discoveries in the annals of medicine: And that 
your well meant endeavours to extend its advantages may 
be crowned with success, is the wish of, 
" Sir, 

" Your very obedient servant, 

« GEO. FARQUHAR, M. D. 

" Of Clarendon, Jamaica.'* 
« Dr. J. R. Coxe." 

An interesting experiment was published here also, trans- 
lated from the French papers, fully substantiating the fact, 
this I also shall introduce as of the highest importance. 

Fron the " Journal die Commerce" a Paris Paper of 
the 24 ih November, 1801. 

" General Committee of Vaccine. 
" A long and important experience having entirely con- 
vinced the committee of the very little danger attending the 
inoculation of the Vaccine (or Kine-pock,) there remained 



63 

to ascertain more particularly its preservative eiFeCts, and to 
mid out whether its duration, respecting which some doubts 
had been entertained, would extend beyond the revolution 
of a year. In order to make this experiment with all the 
care and the authenticity which it deserves, the committee 
assembled together as great a number as they could possibly 
find, of the ablest and most eminent doctors of physic. It 
now publishes the result of the counter-experiments made 
in their presence, upon one hundred and two children who 
had formerly been vaccinated. 

" Verbal-process of the counter -experiment. 
" We the subscribers, being invited by the central com- 
mittee of Vaccine to attend the process of a counter-expe- 
riment which it had in contemplation to make, by inocu- 
lating with the Small-pox a great number of individuals 
who had previously been inoculated with the Vaccine , 
met accordingly at the house of citizen Thouret, Director 
of the Medical School, on the 23d and 30th Vendemaire, 
7th, 19th and 30th Brumaire, year 10, to witness the ex- 
periment and to examine into its results. In each of the four 
first sittings, the committee presented us a person having 
the Small-pox well characterised. The matter which served 
for the inoculation was at each time taken out of the pus- 
tules, and introduced in our presence, by three incisions at 
least, to every individual who had been formerly vaccinated. 
" Thirty-seven who submitted, the 23d Vendemaire, 
to the Variolous inoculation, have been attended by several 
amongst us, until the 30th of the same month, and visited* 
the same day by every one of us. The punctures were 
dried up on twenty-four :< The other thirteen had some 
local effect, characterised by a hard tumid redness, with a 
small suppuration at the puncture. The dessication was / 

complete on the 6th Brumaire, the thirteenth day after the 
insertion. It has been satisfactorily proved that during the 
whole time no febrile affection has been experienced, and 
there was not on any of these individuals the least sign of 
general disease, or the smallest appearance of eruption. It 



64 

is necessary to add, that most of the children had on very 
coarse linen and thick harsh clothes, the friction of which 
seemed to us to have considerably increased the degree of 
inflammation which manifested itself at the incisions. 

M Twenty more have been inoculated on the 30th Vende- 
maire, with the same precautions as the first thirty-seven ; 
that is to say, with matter taken from a Variolous patient 
then present ; on the 7th Brumaire the punctures were ex- 
tinct on nineteen ; one only presented, like the preceding 
thirteen^ a local effect, which had completely disappeared 
the 12th Brumaire, being the twelfth day from the inser- 
tion. 

44 Twenty-five more underwent, on the 7 th Brumaire, the 
same Variolous inoculation. The 15th (the eighth day of 
the insertion,) no marks could be traced of the punctures on 
twenty-three ; the two others presented yet some symptoms 
of local inflammation, resembling that above mentioned, 
and which did not continue longer. 

" Lastly, on the 19th Brumaire the experiment w T as ended 
by inoculating in the like manner twenty individuals. On 
the 30th of the same month the punctures were dried up 
on eighteen. Of the two others, . one presented on each 
arm a hard dry brown scab. The second showed on the 
right arm two rounded regular pustules, the borders of 
which were still lightly inflamed, full of a purulent mat- 
ter and having a Variolous aspect. These two patients, 
attended every day by two of us, have had no symptoms 
of fever, nor any appearance of a general eruption. It is 
necessary to observe that at the moment of the inoculation 
of these two, they were undergoing an anti-venereal treat- 
ment. 

44 It follows from this experiment, . 

44 1. That out of one hundred and two individuals, for- 
merly inoculated with the Vaccine, (several of whom had 
been so for a year, and some others even for near eighteen 
months) the Variolous inoculation has produced no effect 
©n eighty-eight of them. 2d, That the temporary inflam- 




65 

nation noticed at the punctures of the other fourteen, has 
not been followed with the Small-pox, as no symptoms of 
fever, uneasiness, or eruption were perceived on either of 
them. 3d. That in the last case, the pustules of a Vario- 
lous appearance were the effect of a local action, similar to 
that which can be excited by inoculating the Smali-pox on 
individuals having formerly had that malady, and which 
will also be often contracted, even after having had it, by 
Physicians and nurses attending upon Variolous patients. 
4th. Finally, that it is natural to conclude the Vaccine has 
preserved from the Small-pox the one hundred and two in- 
dividuals who had been inoculated with it in our presence. 

" Signed, in Paris, the 30th Brumaire, year 10, (21st No- 
vember, 1801). Maloet, Descemet, I. Roi, Andry, Mon- 
taigu, Barrie, Delaporte, Roussille-Chamseru, Rousset-Van- 
zeme, Doctors of the ci-devant faculty of medicine at Paris : 
■ — Portal, Halls, Jussieu, Fourcroy, counsellors of state :- — 
Parmentier, Huzard, Tessier, members of the national insti- 
tute : — Sue, Dubois, Chaussier, Petit-Radel, professors of 
the medical school : — Heurteloup, Biron, Vergez, La Croix, 
of the council of health of the armies : — Bichat, Anvity, 
Dupuytren, Alibert, of the society of the school of medi- 
cine: — Tourdes, professor of the school of medicine of 
Strasbourg : — Sedillot, jun. of the society of medicine of the 
Louvre : — Ruffin, Bertin, Le Blanc, Leveille, Bourdette, 
Moreau (de la Sarthe.) 

" The committee wishes, if there remain any objections 
to set forth against the Vaccine, that they may be founded 
upon facts as well authenticated. 

■ " Signed, by all the members of the committee, Paris, 
30th Brumaire, year 10. Thouret, President; Guillotin, 1. 1. 
Leroux, Pinel, Doussin, Dubreuil, Salmade, Desches, Ja- 
delot, Marin, Parfait, Mongenot, Husson, secretary. 
" A true copy, 

•« (Signed) HUSSON, Sec'ry." 

[9] 



66 



Mr. Ring who is very sanguine in the cause, had at the 
time of his writing vaccinated about 800, and speaks of 
its proving efficacious in every instance wherein he tried it, 

To these I shall only add, that I have now tried its 
efficacy in above thirty of my patients who had been pre- 
viously secured by the Vaccine. In most instances I made 
two or three punctures, with Variolous matter recently 
taken from persons labouring under the natural disease ; and 
in several instances I repeated this two, three, or four 
times added to which, I have exposed several persons 
to the chance of taking the Small-pox, by causing them to 
visit patients labouring under heavy burdens of that disease. 
The result was an uniform opposition to the variolous con- 
tagion. In two or three instances alone a local pock took 
place on the inoculated part, unaccompanied by eruptions 
or any febrile indisposition. This it is well known will 
frequently occur by inoculation after the Small-pox itself. 
By far the greatest number however died away, so as in 
four, five, or six days, to leave no trace of the attempt : 
Among these I am happy to add, w r as an infant of my own, 
who was ineffectually inoculated three times, after passing 
through the Vaccine at three weeks old ; since which he 
has been held for above one-fourth of an hour in the 
arms of a man, then full of the Variolous eruption. Con- 
vinced as I was before, this was only an additional cause of 
gratitude to the illustrious discoverer of so great a blessing ; 
whose name I have endeavoured to render familiar to my 
family, by prefixing it to the surname of the infant above 
mentioned.* 

I might go on to transcribe beyond all bounds, the nu- 
merous facts which testify the absolute efficacy of Vacci- 
nation in preventing the Small-pox. This is however quite 
unnecessary ; for whoever will not yield implicit belief to 

* The number of persons Vaccinated In London, amounted in Au- 
gust 1800, to fifteen thousand, of which five thousand had been ino- 
culated without effect. 



y ears. 




Years. 


53 


Joseph Merret 


25 


50 


Richard Hay don 


25 


40 


% Mrs. Hutchins 


20 


38 


§ Mr. Deacon 


16 


31 


Mrs. Thurkle 


14 


27 


Wm. St ruche omb 


10 


26 


Mr. Collinhridge 


10 



6 7 

the testimony already adduced, would not be convinced, 
though one should rise from the dead. 

As many have imagined the Vaccine is only a temporary 
security from the Smal!-pox ; I shall endeavour to point 
out the error of this impression, by merely noting down 
the names of various persons who have, at an early period 
of life taken the Casual Cow-pox, by milking an infected 
cow, and who have been repeatedly exposed to the hazard 
of the Small-pox both natural and inoculated. 

John Phillips 
* Mr. Williams 
f Air. Crocker 
Eliz. Wynne 
Mary Barge 
Sarah Portlock 
Hester Walkley 

Mr. Fermor in his " Reflections on the Cow-pox" is full 
of similar facts from three to 36 years. 

These are surely sufficient to establish the fact : But as 
time advances, facts increase to prove its efficacy, whether 
produced by inoculation or in the casual way. Ring men- 
tions one of five years standing by inoculation, and hun- 
dreds may now be enumerated. As therefore it has, when 



* This person has thirteen children who have all had the Small- 
pox, and he himself, besides attending them during their illness, has 
been four times ineffectually inoculated. 

f This man has been frequently exposed to the Small-pox ineffec- 
tually : he is a plumber, and has soldered up coffins containing those 
who died of it. 

X About five years after, she was inoculated, with one hundred 
others : All took the disease but herself, during which she attended 
to them. Since this she has nursed eight or nine persons in the 
Small-pox, three of whom died, and were laid out by her. 

§ Ten years afterwards he and his family were inoculated. Que 
Crf the children died, the rest had it badly : He escaped. 



taken casually, preserved the system nearly sixty years ; 
and as the early cases of Vaccination still continue to op- 
pose the Small-pox, we must regard all opposition on this 
head as mere cavil, and treat it with the contempt it merits. 
I will however go so far as to say, that if it was proved to 
be a preventive for only ten years, it would be an object 
of the highest importance ; for what : comparison can be 
drawn between the ferocious Small-pox and this mild dis- 
ease. I would rather suffer Vaccination every year, than 
run the hazard of inoculation once in my life.* 

To estimate more fully the superiority of the Vaccine, 
it is only necessary to observe, that neither heat nor cold 
are objections to its use ; damp cold weather is to be avoid- 
ed, though it is not very material. f Teething in children 
need not cause any apprehensions as to its issue ; nor do I 
indeed, from what I have seen or read, know any situation 
which would prevent my employing it. Women within 
a few days of parturition, have been safely subjected to it, 
and Dr. Jenner mentions an infant of only twenty hours 
old, who had undergone its influence. I need not enlarge 
here on the feelings of a parent when witness to the suffer- 
ings of an, innocent victim to the Small-pox. Fever, fre- 
quent convulsions, the numerous pustules at times, the dis- 
agreeable object, the chance of pitting, anxiety, and fa- 
tigue of body and mind ; all form a striking contrast with 
the benignant Vaccine ; which causes no emotions but 
those of gratitude to our SUPREME CREATOR, for 
thus kindly counteracting one of the greatest scourges of 
the human race. 

I have not as yet said much on one of the most essential 
points of difference between the two diseases, viz. the non- 
contagious nature of the Vaccine. It is this which renders it 



* If the Vaccine was not invariably a preservative against the 
Small-pox, it would only then be on a par with this last disease, of 
\yhich I shall hereafter give some strong cases of a second attack. 

f See note, p. 51. 



69 

so great a benefit to mankind. The fact is confirmed by 
numerous examples in the practice of almost every Physi- 
cian who has seen the disease. Dr. Jenner in a letter to 
Mr. Ring says, " by no means that I could divise, have I 
been able to infect a person by the effluvia of the simple 
Cowrpock pustule, although I have tried several. Among 
others, I have suffered children two or three times a day 
to inhale by the mouth and nostrils the effluvia of pustules 
on the arms of others, when the matter has been in its 
most active state, and the pustules punctured in several places 
to give the matter its fullest effect." (p. 84). 

It is unnecessary to enlarge on this point. Every Phy- 
sician must have witnessed the fact ; I have had repeated 
instances. I shall only add, that independently of the value 
arising from its non-contagious nature, so mild a disease is 
it considered, that in the Army and Navy of Great Britain, 
the persons Vaccinated, are not considered proper subjects 
for the sick list. 

It is a surprising fact in the history of this extraordinary 
disease, (for such it is in whatever point we view it) , that 
although it is a most perfect preservative against the Small- 
pox, it is not so with respect to a second attack of it- 
self; neither is it prevented universally, by having previous- 
ly undergone the Small-pox. It has already been observed, 
that like the Small-pox, it is communicated with much more 
ease in one instance than in another. The cause of this sin- 
gularity will perhaps never be developed. In all probabili- 
ty, they, whose systems are opposed to one disease, will 
likewise oppose the other. 

Although I have had the disease in my own person in the 
most favorable manner, yet as some have supposed it to be 
merely local, I shall not depend on this alone to prove the 
fact, but shall briefly enumerate several instances from Jen- 
ner, Ring, and others. 

Dr. Jenner at p. 20 of his Inquiry, relates the case of 
Wm. Smith, who had the disease in 1730, 1791, and 1794, 
which was equally severe in each attack; and at p. 47, 



7o 

he gives a yet stronger instance of Eliz. Wynne " wh» 
had the Cow-pox in the year 1759, was inoculated with 
Variolous matter without effect in 1797; and again caught 
the Cow-pox in 1798." 

Dr. Jenner supposes " the susceptibility of the virus of 
the Cow-pox is, for the most part, lost in those who have 
had the Small-pox, yet in some constitutions it is only par- 
tially destroyed, and in others it does not appear to be in 
the least diminished." To this remark he adds that some 
il have had the disease in the most perfect manner," and 
gives a very strong case of this kind which had been pre- 
sented to him by Mr. Fewster, p. 165: occ. 

In addition to these facts, Mr. Ring asserts p. 135, that 
many years after having undergone the Small-pox, he suc- 
ceeded in exciting a perfect Vaccine pustule on each arm of 
his nephew Mr. John Ring: At p. 121, he gives us another 
example, where a lady was inoculated, in jest, by her hus- 
band, with Vaccine matter taken on the point of a needle 
from one of her children, and had the disease in the ?nost 
perfect manner, and accompanied with head-ach and fever. 

I shall not take up time in referring to more cases. I 
will only add, that I have seen no pustules more perfect than 
those which appeared on my own arm, and on that of a 
student of medicine who having had the Small-pox previous- 
ly, vaccinated himself successfully with infection from the 
arm of his fellow-student (see case 10,) who had the di- 
sease excited in him bv matter from one of my pustules. 

Although several persons have thus successfully excited 
the Vaccine disease after Small-pox, I must not omit to add 
that such experiments more frequently fail. The following 
extract from a letter, of Dr. Waterhouse on this point, is of 
.sufficient importance to authorise my introducing it here. 
It is dated Cambridge, March 28th, 1802. 

" From all that I have hitherto found in the English 
publications, and from my correspondents, I am induced to 
i*ay, that the greatest weight of evidence is on the side of 
that opinion which maintains, that he who has actually 



7i 

gone through the Small-pox can never have the Kine-pax; 
and all the experiments I had hitherto made, added to this 
weight. I nevertheless determined to make a few more 
trials, as experiment alone must decide it. 

" I accordingly inoculated seven persons with Kine-pock 
matter who had gone through the Small-pox, myself being 
of the number, four others were in my own family; the o- 
ther two in the neighbourhood. By the fourth day I was 
able to pronounce, that six of them would not have the ge- 
nuine Vaccine pustule. They inflamed too quick; the ino- 
culated part resembled the sting of a bee, and wanted the 
requisite hardness, as well as that deep-seated, well-defined, 
and slowly-progressing affection, which characterises the ge- 
nuine incipient pustule. Add to this, on the eighth day the 
inflammation surrounding the puncture was rather an erysi- 
pelatous blush than the beautiful efflorescence depicted in the 
engraving I sent you.* In thirteen or fourteen days the af- 
fection on the arm vanished, leaving scarcely any mark be- 
hind. I forgot to mention that although they had pain un- 
der the arm, they had not the least febrile symptoms. Six 
or eight months ago, I inoculated six children in one fami- 
ly, one of whom had had the Small-pox. The difference 
in the pustules was striking through every stage, but near 
enough to deceive the unexperienced. Limpid matter was 
in all of them, and I presume I could have communicated 
the genuine distemper with equal ease from either. 

" But, what shall I say of my own case? Mine was al- 
most totally different ; I had inoculated myself in the hollow 
space between the finger and the thumb of my left hand, 
(between the abductor indicis and adductor pollicis), and I 
thrust into the same part of my right hand a splinter, or 
small fragment of wood, in order to see the difference be- 
tween the operation of a poison and a. simple extraneous 
substance. 



* This is the engraving from which the plate is copied, which is 
introduced into this treatise. 



74 

" On the fourth day it had every mark of the perfect In- 
cipient Vaccine pustule. On the fifth day it had still strong- 
er characteristic signs of the true pustule, in so much, that I 
should not have hesitated in pronouncing it as such, in an 
ordinary case. On the sixth I had pain and swelling under 
my arm, and a perfectly pellucid fluid was found in the ve- 
sicle. On the evening of the seventh day I had, or conceited 
I had, a dizziness and nausea ; so that had I written to you 
^on the subject at that period, I should not have hesitated in 
saying that I was under the true disease, notwithstanding I 
felt confident, that I received the true Small-pox by inocula- 
tion from the skilful hands of the venerable Dr. Redman in 
1774: but had I written twenty-four hours later, I should 
have retracted the opinion, because at that period, when 
the pustule ought to have increased in turgescehce, and to 
have blazed forth in the form of a bright efflorescence, it 
became flaccid, faded, gradually subsided, and vanished a- 
way, pretty much as the Variolous' inoculation does after 
the Vaccine. Had the local affection increased on the eighth 
and ninth days, and the constitutional symptoms been aug- 
mented, I should have joined in opinion with you, that a 
person could go through both diseases perfectly; but at pre- 
sent my experience is against it, and you will understand I 
mean only to speak of my own experience. 

" A little girl in this town, who had been inoculated for 
the Small-pox in her infancy, took some of the Vaccine vi- 
rus on the point of a needle from the arm of a servant-maid 
in the family, on the ninth day from Vaccination, and with 
it pricked her own arm, merely out of sport. The infecti- 
on w r as perfect, and the distemper went on regularly through 
the three requisite stages of vesication, efflorescence, and 
scabbing, and the coincidence of symptoms was exact. I 
never saw a more perfect case of the Kine-pock. With 
matter from her arm I communicated the genuine disease to 
a third person. This, to me extraordinary occurrence, de- 
termined me to make a critical inquiry into the circumstan- 
ces of her inoculation, both of her family and of her ino- 



13 

culator, and am entirely disposed to believe that she never 
had the genuine but spurious Small-pox. 

" From my own case, may we not infer that the Kine- 
pock virus is capable of vaccinating the skin and of raising 
a genuine pustule, and of affecting the lymphatics as every 
other acrid matter will, with redness, swelling and pain; 
but that the susceptibility of the constitution to its action 
was destroyed twenty-eight years ago by the Small-pox, 
which seizing on its appropriate pabulum consumed it so 
entirely, as not to leave enough behind to rekindle on 
the application of the Variolous or Vaccine flame? or 
should this savor too much of the old humoral patholo- 
gy, let us say if you please, it was by destroying the Vari- 
olous, or peculiar excitability, or susceptibility to a second 
impression : How else can we account for the apparently 
perfect, yet short lived and abortive pustule that was raised 
on my hand? We see it was incapable of going out 
its full time, being void of certain requisites essential to its 
perfection ; otherwise the lymphatic, sanguiferous, and ner- 
vous sv stems, would not have refused their action, and forbad 
that febrile commotion which seems to constitute the very 
essence of exanthematous disorders. Dr. Jenner is of opi- 
nion that persons who have had the Small-pox are suscepti- 
ble of the Cow-pox only in a small degree. So they are 
of the Small-pox itself in a small degree : If it be found 
on deliberate experiment, that those who have really had 
the Small-pox are not in general liable to the Kine-pock, 
excepting in a slight degree, I think it of some importance 
to have it known. If there occur cases that appear to be 
exceptions, they should be carefully watched and as careful- 
ly recorded. Such cases I rank with those where a person 
has had the Small-pox twice, which although very rare in- 
deed, I have no doubt have occurred. " 

Of this letter I can only say, that as I certainly experien- 
ced the full effect of the Vaccine in my own person, I am 
less disposed than Dr. Waterhouse, to consider the previous 
[ 10 ] 



74 

disease of the little girl, as a case of spurious Small-pox!* 
Nor can I altogether concede, that the Doctor's own case was 
not a perfect one, though uncommonly rapid and unaccom- 
panied by an areola. Indeed I have a very confident hope, 
that Dr. Waterhonse is on the point of embracing the op- 
posite doctrine from that which he here maintains ; at least 
I judge so from the following extract of a letter with which 
he has lately favored me, of the date of May 26th. " I 
have lately received a well attested case of the Kine-pock 
after the Small-pox from Vermont. The subject was a me- 
dical gentleman. The question still remains subjudice."* 

* As the great rapidity of the disease in the Doctor's own case, 
appears to influence his belief on this point ; I am induced to add 
the following case, in addition to others which may be seen in the 
tables, as a convincing proof, that the disease may be very quick 
in its progress, and yet be a certain preservative against the Small-pox. 

Elizabeth Gallagher, aged 28, a servant at the Philadelphia Dis- 
pensary, was vaccinated at n A. M. of Thursday, May 13th, with 
recent infection from a child on the 10th day of the disease, at which 
time the areola was at its height. One puncture was made on each 
arm, and one on the right fore-arm. On the 14-th, a pimple appear- 
ed at each puncture attended with considerable itching. On Sunday 
the sixteenth she experienced drowsiness, with pain of head and hack ; 
On Monday seventeenth (fifth day), nausea and vomiting, and a 
perceptible areola ; on Tuesday, pain and swelling of the axilia, the 
areola extended full four inches downwards to the wrist, (on the right 
fore-arm), and united above with that which formed around the pock 
on the arm. The inflammation was considerable, and Saturnine appli- 
cations were employed. On Thursday evening (eighth day), a scab 
commenced on the pustules, and was nearly complete by Friday after- 
noon. A part of the pock on the right fore-arm at its circumference 
still contained a limpid flu':d, which I employed in vaccinating, but 
it failed to infect. On Monday, twenty-fourth (twelfth day), the 
scab of the left arm came ofFj that on the right was separating round 
its circumference. On Tuesday, twenty-fifth (thirteenth day), I in- 
oculated her with recent Variolous matter in three places of the left 
fore-arm. They swelled and inflamed for a few days, and then died 



75 

After what has been said of the mildness of this disease, 
and die absence of the areola in many instances, it may per- 
haps be difficult to fix upon any absolute criterion of the ex- 
istence of a constitutional affection. The fact is however 
so ; and itappears to demonstrate the improbability of the sup- 
position of the Vaccine and Small-pox being originally the 
same ; or rather that the Vaccine is the parent stock, from 
which the Smail-pox has deteriorated, its difference only 
depending on the length of time in which the latter disorder 
has passed through various constitutions in the human race. 
That this is not the case, is rendered certain in my opinion, 
not only from the existence of the Vaccine after the Small- 
pox, but also from our knowledge of the inveteracy, and 
contagious nature of the Small-pox, ever since our first ac- 
quaintance with it; These appendages have been constantly 
uniform and not progressive, in a long series of years : we 
cannot therefore suppose it to have originated from the Vac- 
cine, and gradually to have acquired its present malignancy; 
as we must at the same time suppose it to bt worse at pre- 
sent than at any preceding period. Could we even get over 
the idea of its gradual deterioration, how is it possible to 
account for the contagious property of the Small-pox, and' 
at what distance of time from its supposed source, the Vac- 
cine, did this extraordinary property commence ? This pro- 
perty We ought on the same principles to find increasing : 
but no one will contend the Small-pox is a more violent di- 
sease at present, than it was a century ago. 

The reverse of what happens, we should rather expect ; 
for we might readily imagine, a priori, the more violent 
Small-pox would be capable of amelioration, and that be- 
sides preventing a recurrence of itself, it might also prevent 
the Vaccine : But we could not so readily expect this mild 

away and disappeared. On the thirty-first they were gone; when it 
was again repeated with a similar result. It may be proper to remark, 
that from Thursday the thirteenth to Tuesday following, she had an 
unusual flow of the menses ; what influence it had on the disease 
J know not. 



7 6 

disease to be a perfect sdcurity against the Small-pox, and 
yet neither to be an absolute guard against its own recur- 
rence, nor yet to be invariably prevented by the more violent 
Small-pox. As fact however proves the truth of this ; it 
serves to shew how little dependence is to be placed upon 
Theory, when it departs from the broad and firm basis of 
experience, to revel in the fertile fields of fancy. 

A very important caution remains yet to be pointed out, 
viz. that the Vaccine is by no means to be considered as 
an absolute preservative against the Small-pox, unless the 
system has been completely guarded by it, previously to 
inoculation, or exposure to the natural contagion. This 
cannot perhaps be the case before the ninth or tenth days.* 
If a person be inoculated in one arm for the Small-pox, and 
in the other for the Vaccine at the same time, he has sure- 
ly no right to expect the extinction or even suspension of 
the one by the action of the other. Both at this period ex- 
ert an equal sway on the system, for neither have a prior 
claim : and hence, in all probability, both diseases will run 
their course together; though from the accounts of authors, 
and from several cases which have come under my care, I 
am induced to believe the Vaccine prevents the Small-pox 
at this early period; and that when it is not prevented, its 
symptoms are for the most part moderated. I shall here be 
pardoned for introducing a case, in which I was satisfied the 
Small-pox was suspended by the progress of the Vaccine, 
but resumed its course after the termination of that disease. 
(See case 14.) 

On the evening of the 28th of November, I was desired 
to see a woman labouring under a violent attack of fever 
which had continued three or four days. The next morn- 

* If a person at this period be exposed to the Small -pox, as the 
system is not perhaps completely guarded j certainly it should be no 
objection to the Vaccine, if we should find the Small-pox shewing it- 
self in the course of two weeks, that is, twenty-four days from vac- 
cination. 



77 

inp , she was covered with an eruption of Variolous pustules. 
She then told me, that precisely two weeks before (Novem- 
ber 14th), she had visited a friend in the same chamber 
in which a person lay ill with the Small-pox. Her husband 
accompanied her but went no farther than the door ; near 
enough however to see the person abovementioned. As he 
had never had the Smaii-pox, I resolved to give the effica- 
cy of the Vaccine, a fair trial, and immediately vaccinated 
him, by two slight incisions of the left arm, in which i de- 
posited a portion of infected thread, ten days old. By the 
commencement of the third day, it had evidently taken effect. 
As he was constantly in the room with his wife, I put him. 
on a low diet, and gave him occasional doses of medicine : 
he did not however abstain from his daily labour. On the 
evening of the seventh day he complained of pain and swel- 
ling of the axilla, which increased till the ninth day and then 
gradually subsided. On the eighth day the Vaccine pustule 
afforded me matter in considerable quantity; and there was 
much pain in the part shooting up to the axilla. This night 
he had a considerable degree of fever which continued all 
the next day, and towards evening was accompanied by pain 
of the head and back, and also with nausea and vomiting. 
On the tenth day several Small-pox pustules made their ap- 
pearance on the face, arms, and breast, from which period 
the fever declined, both diseases progressed distinctly, and 
by the fifteenth were drying away. By the seventeenth 
he was quite well. Indeed he suspended his daily labour 
(of sawing) for only about three days. The day of the 
Variolous eruption was the tenth of the Vaccine, and twen- 
ty-five days from his exposure to the source which produ- 
ced the disease in his wife. That he could not have ta- 
ken it from his wife, is evident from the eruption appear- 
ing in ten days from its first coming out on her; which 
is too short a period in the Natural Small-pox. Two 
weeks is I believe the shortest period of the Variolous 
eruption taking place in the natural way; this was ex- 
actly the case in a child of about three months old, whom 



7 3 

i Vaccinated at the same time with this man, and who 
was constantly in the same room with him and his wife. 
The vaccination succeeded in the most perfect manner, 
yielding a plentiful supply of matter on the seventh, eighth 
and ninth days, at which time he seemed slightly indispo- 
sed, and apparently experienced pain in the axilla. . This 
subsided bv the eleventh or twelfth day, when a scab 
was forming. A new set of symptoms took place on the 
thirteenth, viz. a considerable degree of fever, &c. which 
continued till near the beginning of the sixteenth day • 
when three or four very perfect Variolous pustules appear- 
ed on the face, which maturated rapidly, and were nearly 
dried up by the twentieth day. 

It may perhaps be said that the man might have escaped 
the first exposure to the Variolous contagion, and have 
taken it from another Source. This however is unlike- 
ly: I took considerable pains to find out if he had been 
exposed to any other source, but had every reason to be- 
lieve he had not ; I therefore felt perfectly assured that the 
first impression of the Vaccine upon the system, was to 
suspend the Variolous action then existing; but that it 
was incapable of destroying it, from its having got sq 
greatly the start ; hence its progress was resumed as soon 
as the constitutional symptoms of the Vaccine began to 
decline. I doubt not the Variolous contagion was mode- 
rated also in both the above cases, certain it is the matu- 
ration of the pustules was much more rapid than usual.* 

It may not be uninteresting to remark of the last men- 
tioned case, that about three weeks from the time the 
scabs were completely formed, I was told the child was 



* How far the Vaccine has the power to suspend and prevent the 
Small-pox after the contagion has been received into the system, I 
cannot say. Certain it is that many persons do not take the Small- 
pox though exposed to its influence, and such accidental coincidences, 
may be thus ascribed to the Vaccine in many instances, when in fact 
the Vaccine had nothing to do with it. 



79 

broken out with a second attack of Small-pox. It was 
however only the Chicken-pox which he caught from a 
boy in the same house who had broken out about ten days 
before. He was slightly indisposed for a day or two 
preceding the eruption, which continued to come out three 
days, and then rapidly dried away. The fluid in these pus- 
tules continued limpid till the last, which is not the case 
in the Small-pox. 

I have seen five cases of the union of the Small-pox and 
Vaccine, in three of which the febrile symptoms of the 
Small-pox occurred (and not very lightly) about the period 
of the constitutional symptoms of the Vaccine ; and hence, 
I would wish again to enforce the caution I above menti- 
oned, viz. not to consider the Vaccine as a preservative 
against the Small-pox before it has completed its action on 
the system; which probably is seldom before the ninth or 
tenth days. Before this period then, it js highly improper to 
run unnecessary risk by exposure to the Small-pox, or by in- 
oculation ; although I have no doubt that it will frequently 
prevent the disease, even after having been several days ex- 
posed to the contagion ; of this Dr. Jenner gives some stri- 
king instances at p. 168, 169, of his invaluable Treatise, on 
the authority of Mr. Lyford, and his nephew the Rev'd. 
G. C. Jenner. In one instance two -children escaped who 
had, previously to Vaccination^been exposed five days to 
the Variolous contagion from their father. In the other, 
a family of a man, woman, and five children, were vacci- 
nated four days after being exposed to the constant action 
of the Variolous poison. It took effect on all but the 
mother, who. consequently had the Small-pox. These 
cases are sufficient to prove my position; but will not war- 
rant unnecessary exposure. 

Several circumstances which have been mentioned seem 
to lead me to say a few words on the possibility of two 
diseases existing in the system together. As this involves 
one of the most favorite doctrines of the present day, I shall 
certainly be excused for collecting together several import- 



8o 

ant facts on this head, from various sources. Theory can 
have but little ground in a dispute, where fact at last must 
determine the question. 

I have already stated the cases which have come under 
my observation of the combination of Small-pox and Vac- 
cine ; not in succession, but at the same time, and with- 
out the least suspension of action. To this I mav add that 
almost all the cases of Dr. Woodville, tend to prove the 
same. No reasonable doubt can I believe be entertained, 
that one disease at times will overpower, or suspend ano- 
ther, as in the instance related by the celebrated Mr. John 
Hunter, of the Measles and Small-pox, and on which he 
has founded this favorite hypothesis. It is very unfortu- 
nate that this fact, with others of the same nature, have 
been considered as so thoroughly establishing the position 
above mentioned, that a contrary opinion, though backed 
by facts from different sources, has been considered unwor- 
thy of investigation, and has even been treated with ridi- 
cule, as I have seen. This is more to be wondered at, be- 
cause as merely a matter of fact, its truth might have rea- 
dily been ascertained ; and the arrival at that truth, I am 
satisfied is the great object of the researches, of the advo- 
cates of both opinions. 

I shall not take up time at present by detailing the cases 
of combined Vaccine and Small-pox which have come 
under my notice. I shall present to the public, cases in 
point, from various authors, sufficient I apprehend to esta- 
blish the position. As it would occupy unnecessarily a 
large portion of time to detail each case, 1 shall refer to the 
works where they are to be found. 

Dr. Jenner, p. 137, gives an interesting case of coex- 
istence of Measles and Cow-pox, where both diseases ap- 
pear to have run their course without any sensible interrup- 
tion, except a slight temporary suspension of the efflores- 
cence, which had not appeared on the twelfth day, but 
advanced in the usual manner before the pustule scabbed. 
As there exists, however, so great a variety in the appearance 



of the efflorescence, I am not disposed to consider this late 
period of its appearance as any way depending on the 
Measles ; the constitutional symptoms of which must have 
subsided long before. 

At p. 170. Dr. Jenner relates a very striking case of coex- 
isting* Vaccine and Scarlatina Anginosa, in a young lady. 
On the evening of the eighth day from Vaccination she 
was seized with symptoms denoting the accession of vio- 
lent fever accompanied with sore throat. The next day 
the redness of the skin took place ; it pursued its usual 
progress, as did also the Vaccine pustule without any de- 
viation, except that, as in the last case the areola did not 
appear until the Scarlatina retired. The same reason may 
be urged against the opinion that the existence of the Scar- 
latina prevented the areola. 

I cannot omit mentioning the case immediately follow- 
ing the one above, which is extremely interesting, as it 
proves the entire occasional suspension of one disease by 
another. The sister of the last mentioned case, who was 
exposed to the contagion of the Scarlatina at the same 
time, sickened almost at the same hour. The symptoms 
were severe about twelve hours, when the rash faintly ap- 
peared on the face and neck ; in two or three hours it sud- 
denly disappeared, leaving her free from complaint. The 
inoculated pustule had in this case the efflorescence sur- 
rounding it, which began on the fourth day to die away, 
and the pustule to dry up ; when the Scarlatina again ap- 
peared, and spread all over her, accompanied with the sore 
throat and common symptoms of the disease. 

Ring abounds in instances of the combination of diseases, 
either from his own authority or that of others. 

At p. 107, on the authority of Mr. Leigh ton he men- 
tions three cases of a co-existence of Small-pox, Measles 
and Hooping-cough. The same is stated as notunfrequent 
in the Marybone infirmary by Dr. Rowley, p. 267. At 
p. 108, he says he had within six months met with three 
cases of the co-existence of Cow-pox and Measles. Mr. G. 

[ ii ] 



82 



fenner he adds, had lately met with a similar case; and iri 
all these cases the periods of the respective eruptions vari- 
ed ; in one the Measles appeared on the second day, in the 
second on the eighth, in the third on the fourth, and in the 
fourth on the eighth ; but in neither instance interrupting 
the progress of the Vaccine. In these also the Areola was 
perfect. A case of Cow-pox and Chicken-pox, occurred 
to Mr. Little of Plymouth, (see Ring p. 109), the latter ap- 
pearing on the tenth day of Vaccination, when the pustule 
.had arrived at its height of inflammation. 

At p. 267, he mentions a patient of Mr. Sandy's in 
whom the Measles and Small-pox appeared on the same 
day, and both eruptions went on together. 

At p. 268 he mentions several cases of the co-existence 
of Cow-pox and Small-pox ; the latter disease appearing 
the third, sixth, seventh and eleventh days. Various other 
cases are enumerated. 

A gentleman in this city gave me an account of the 
Vaccine and Itch combined. 

The following account of co-existence of Small-pox 
and Measles, by Dr. Patrick Russel, is taken from the Medi- 
cal and Physical Journal of July 1800. The facts are 
powerful stumbling blocks to the opposite opinion. 

These cases occurred at Aleppo in 1765. The follow- 
ing is the history in the Doctor's words. 

" In the month of March, an instance occurred where 
both diseases were conjoined in the same patient. The 
subject was a female child two years old, of a pale deli- 
cate complexion. The redness of the eyes, the coryza, and 
the cough which accompanied the fever, led me to expect 
the Measles. On the fourth day, the eruptions of the Mea- 
sles were visible on the face, the neck, and the back ; but 
at the same time a few eruptions of a different kind were 
interspersed on the face and neck, which if they had been 
the sole eruption, I should without hesitation have de- 
clared to be the Small-pox. The progress of the pustules 
on the fifth proved them to be Variolous. Both eruptions 



83 

were of a favorable kind, and distinctly pursued their re- 
gular course. On the eighth day, the Measles were fading 
fast, while the Variolous pustules on the face were near 
their height. The pustules were not numerous, were very 
distinct, and ripened perfectly. The cough continued to 
be a troublesome symptom, especially in the second week. 
A diarrhoea supervened about the fourteenth day, and con- 
tributed to render the child's recovery very slow. 

" In the month of April I met with a similar case. A 
healthy boy, three years old, was attacked with the usual 
symptoms of the eruptive fevers, at that time epidemical. 
The cough rather seemed to indicate the Measles. On the 
third day, the eruptions of the Small-pox and Measles made 
their appearance together. The Variolous pustules were 
of the small round kind, and came to perfect maturity, but 
were more numerous than in the former case. The Mea- 
sles were of a fainter colour, and left behind them still 
less of the branny scurf, agreeing in both circumstances 
with the disease then prevalent. ' ? See Med. and Phys, 
Jour. p. 7 1 . 

In p. 29, 30, of the Medical and Physical Journal is also 
a case of the co-existence of Measles and Small-pox, though 
by no means so strong as the above. On the ninth day 
several pustules around the inoculated part were advancing 
to suppuration, on the eleventh some appeared on the body, 
accompanied with fever; on the thirteenth day, whilst the 
pock were still advancing, an eruption exactly resembling 
the Measles, accompanied with the symptoms of discharge 
from the eyes, &c. made its appearance. The two dis- 
eases progressed together till the fifteenth, when the Mea- 
sles began to disappear, and were nearly gone by the seven- 
teenth, at which time the Variolous pustules were also dry- 
ing away. 

A combination of the same diseases is mentioned in two 
instances, in the third volume of the New-York Medical 
Repository, by Dr. Tracy, and ought not to be overlooked : 
I must refer the reader to the work adverted to, for a full 
detail of these interesting cases* 



84 

The following letter from Dr. B. F. Young, of Northum- 
berland, to me, among other interesting information men- 
tions a case of co-existing Vaccine and Measles, besides se- 
veral cases of what I consider as a co-existence of the Vac-* 
cine and Small-pox. 

fj Northumberland, February 27, 1802. 
?* Dear Sir, 

li I have delayed thanking you for your 
letter and the two portions of virus you were so good as to 
send me some time since, in order to communicate more 
fully the result of many trials I made with it. The first 
portion on glass arrived the same evening with an armed lan- 
cet from Dr. James ; this lancet was dipped in luke warm 
water and applied to the glass in such a way as to mix them 
perfectly.* I then vaccinated five children, all perfectly 
well and free from every kind of complaint. Four of the 
five succeeded; my own son had the complaint agreeable to 
Aiken in every particular, and the different changes all took 
place within an hour or two of the time mentioned by him ; 
consequently he had it very favourably. The second took 
sick on the ninth day, which excited my particular attenti- 
on ; the fever increased for three days, and terminated on the 
fourth, in a most plentiful eruption, so exactly resembling 
the Small-pox, that I was apprehensive it laboured under a 
pre-disposition to that disease at the time I put the virus in 
its arm ; their pustules all filled, and are not yet entirely 
dried away ; the third child sickened on the eleventh day ; 
pulse in the morning of the twelfth day 184, at eleven 
o'clock this morning it had a fit, in which the parents de- 
clare it lay half an hour; the thirteenth, fourteenth, and fif- 
teenth days, fever as high as possible, attended with convul- 
sions every two or three hours; in the evening of the fif- 

* The matter sent by me was taken from case 21 on the ninth day, 
and was then forty-one days old. It had been secured between glass 
and coated with gold-beater's skin. 



35 

tecnth clay completely eruptive all over the body, these pus- 
tules as they filled became confluent, so as to cover the bo- 
dy in one incrustation, not yet entirely dried away. The 
fourth child sickened on the fourteenth day, had one severe 
convulsion the night of the fifteenth, and a moderate erup- 
tion the seventeenth day, which filled regularly, and has 
dried away. 

" From the above account it will appear, that I have 
been more unfortunate than perhaps most persons who have 
been in the practice of vaccinating; nor can I assign any 
reasonable cause for three out of four proving pustular: had 
I been less particular in the choice of my patients, or in ma- 
king the puncture or rather scratch in the arm, or the lan- 
cet made use of, I should have felt unpleasant upon the oc- 
casion ; but as it is, I am satisfied that it is an unusual vari- 
ety of the disease, and that they must occur much oftener 
than is generallv supposed. Each of the arms wanted the 
inflamed margin until after the fever, and the edges were 
never well defined. With matter taken from all four of 
the children on the seventh, eighth, and ninth days, I vacci- 
nated thirty-one, three out of which number proved mode- 
rately pustular, not much fever attended either, and no con- 
vulsions ; arms generally inflamed on the eleventh day. In- 
deed I now confidently predict an eruptive Vaccine if the ef- 
florescence does not appear on or before the twelfth day. In 
one case it was completely formed on the seventh day, ow- 
ing to the child's sickening with the measles on the third 
day, and the eruption taking, place on the seventh; on the 
eleventh and twelfth day it disappeared entirely. 

" I shall continue the practice in preference to the Small- 
pox, being perfectlv satisfied, notwithstanding my having 
been so unfortunate in the onset, that it is a much safer and 
milder disease than the other ; and that the number of un- 
pleasant cases will continue to decrease with me." 

To this I returned the following answer. 



26 

" Philadelphia, March 3, 1802. 
" Dear Sir, 

" Your interesting letter of the twenty-seventh 
came safe to hand this morning, and has greatly surprised 
me: Of this you will be convinced when I assure you, that 
of fifty cases of Vaccine which have come under my care, 
1 have met with only two, in which any other pustule but 
that on the vaccinated part took place. In these, besides the 
local pock, one other appeared in each, the particulars of 
which I shall give in a publication I am slowly preparing 
for the press. 

" 1 am however clearly of opinion that the Variolous infec- 
tion has in some way crept in among the cases you mention. 
My opinion is formed on the following reasons. Your son 
having the disease so favourably, whilst the remaining four 
suffered so considerably, though vaccinated with the same 
infection, seems a strong argument for supposing their pre- 
vious exposure to the Small-pox. The exact resemblance 
of the eruption to the Small-pox, and its confluence in one 
instance accompanied also with alarming convulsions, are 
other difficulties to be removed before I can believe it was 
the Vaccine. The fourth child sickening on the fourteenth 
day, or about the period for the Natural Small-pox; the ab- 
sence of the well defined edges of the Vaccine pock ; which 
I suspect was not the case in your own child, and the al- 
most total absence of pustules in the second set of cases 
you enumerate. 

" I could have wished you had noticed the peculiar appear- 
ance of the local pock, as compared with the general erup- 
tion, and also the appearance of the contents of the pustules 
themselves. Did they become purulent, or did they con- 
tain a limpid fluid to the last? An accurate account of each 
case with any observations which may have since occurred 
to you will be highly acceptable. Did you inoculate the 
second set with matter taken from the local pock, or from 
the general eruption ? Has not the Small-pox been any where 
in your neighbourhood, which might reasonably account; 



»7 

for its occurrence in four of your patients ; whilst your son 
from his youth might not be exposed to the danger ? 

" The matter which both Dr. James and I sent you, was 
taken from patients who had the Vaccine in the most favor- 
able manner. I can therefore in no way account for the e~ 
ruption but by supposing the co-existence of the Vaccine 
and Small-pox, of which I have met with several instances ; 
and of which Dr. Woodville has a still more considerable 
example, in the first cases of the Vaccine which came un- 
der his notice in the Small-pox hospital. 

" Your case of Vaccine and Measles combined is very in- 
teresting; 1 will thank you for the detail. I am collecting the 
various facts of this description which I shall bring forward 
in the publication above alluded to. They appear to be so 
numerous, that the advocates for the celebrated J. Hunter's 
opinion of the impossibility of two diseases co-existing, 
will I imagine find it difficult to explain them away. I have 
no doubt that one .disease is more frequently suspended by 
another, as was the case, in the instance adduced by Hun- 
ter; but these certainly are not conclusive, Sec. &c. 
" In the mean time, I am 
" My dear Sir, 

" Your obedient Servant, 

" JOHN REDMAN COXE." ' 

1 'lie following is extracted from a letter in answer to 
mine, dated May 5th. 

" Since my last communication, I 
have vaccinated upwards of a hundred, and have had but 
one eruptive case, and that very slight. The matter with 
which I inoculated the second set of patients (thirty- five in 
number, two of which proved pustular), was taken from the 
pustule at the puncture on the ninth day. I began with my 
child, and added to the general stock upon the point of the 
same lancet from each of the others as I visited them ; the 
black boy I mentioned as being concerned in nursing 
■ 's child, (the case of violent convulsions), sickened on 



the twenty-first day after I wrote to you ; this proved to bs 
the true Small-pox, although he had it very favourably ; a 
little girl in a neighbouring house also had it. 

" This last circumstance has served to satisfy my mind, 
that the first cases must have been Variolous, although I can- 
not account for the manner in which it was communicated. 

" The Small-pox was not within twenty-five or thirty 
miles of this town at the time of my inoculating them; and 
the parents of each, upon being questioned as to the pro- 
bability of an infected person visiting the family, declare 
they do not think it possible ; the professions of the family, 
being very different, it can scarcely be supposed that the 
same person could have had business with all of them. 

" I have not attempted to inoculate with Variolous mat- 
ter, but shall soon make trial of it. 

" I never ventured to try the effects of matter taken from 
a pustule upon any part of the body, but the inoculated part. 
" With much respect, 
" I am dear Sir, 

" Your's sincerely, 

" B. F. YOUNG." 

" P. S. / have had upwards of thirty cases of Measles 
and Vaccine at the same time, and in two instances the 
hooping-cough." 

If now we allow that credit to the above cases to w T hich 
they appear entitled, we must I think coincide in opinion 
that two diseases may exist together in the system.* Why 

* Mr. Ring says, p. no, " He (Dr. Jenner) also limits the axiom 
of Mr. Hunter to the incompatibility of two diseased actions in one 
and the same part. Mr. Hunter's axiom however was more general, 
in whatever manner it may have been expressed on any particular occa- 
sion. The prevailing hypothesis, that two cutaneous diseases cannot 
make their appearance at the same time, but that one will always sus- 
pend the other, is continually quoted in the Medical Schools and So- 



8 9 

at one time this should be the case, and at another, one di- 
sease should suspend the other, is a curious subject of inves- 
tigation.* I shall now take leave of this part of my en- 
quiry, and proceed to say something of the Spurious Disease. 
I have already observed that genuine matter will sometimes 
produce a spurious disease from some peculiarity of consti- 
tution, I have in the tables mentioned a case of this kind, 
in which five successive attempts either failed or produced 
the spurious disease. (See case 35).f The sixth attempt 
was apparently more successful, for although it got consi- 
derably rubbed, it still retained the circumscribed appearance 
of the true disease. I have not yet tried the Variolous in- 
fection ; A troublesome itching constantly accompanied the 
spurious disease, and the constitutional symptoms occasional- 
ly ran high. Dr. Jenner supposes, and I think with much 



cieties, as maintained by Mr. Hunter; and Mr. Home himself lately 
informed me, that Mr. Hunter was of opinion, two cutaneous di- 
seases could not take place at the same time in the same person. 

" By a reference to the cases of co-existence before enumerated, 
(Dr. Woodville's cases) it will be found, that in some of them, not 
only the patients laboured under two eruptive diseases at the same 
time ; but that the eruption was even synchronous. 

<( But what proof have we, that even the limited action of Mr. 
Hunter is founded on the basis of truth ? Why are two morbid ac- 
tions more incompatible than two healthy actions ? That two, or more, 
healthy actions in the stomach may co-exist, will not, I apprehend, be 
denied. When the peristaltic motion takes place, by muscular action, 
surely no one will maintain, that the action of the nervous or arterial 
system must necessarily be suspended. " 

* I shall mention concisely the diseases which appear to have been 
combined, ist. Measles and Small-pox. 2d. Measles and Vaccine. 
3d. Vaccine and Small-pox. 4th. Vaccine and Scarlatina, 5th. 
Vaccine and Chicken-pox. 6th. Vaccine and Itch, 7th. Small-pox, 
Measles and Hooping-cough. 

f By a reference to my own case, (No. 1) it will be perceived that 
with recent virus taken from a perfect pustule on the seventh day, I 

[ 12 ] 



93 

reason, that these anomalous appearances, sometimes owe 
their origin to the friction of the clothes on the newly inflamed 
part of the arm, and he has at p. 175 given a case, in which 
the punctured part was on the sixth day encrusted with a 
rugged amber coloured scab, instead of shewing a beginning 
vesicle. The scab spread and increased in thickness for 
some days, when a vesicated ring appeared at the edges. 
From the fluid matter five persons were inoculated. In one 
of which it produced a perfect pustule • whilst in three of the 
others a creeping scab of a loose texture was produced, fol- 
lowed by the formation of a limpid fluid at ks edges as in the 
case from which the matter was taken. In these instances 
the Vaccine disposition apparently lay dormant, though the 
vesicated ring proves that it was at length excited to action. 
I presume, matter taken from those cases before the forma- 
tion of the vesicated ring, would have inevitably induced a 
spurious disease. 

The spurious Cow-pox may be induced by inoculating 
with matter taken from a cow, who has not the true disease. 
Attention to the characteristic marks of the true disease as 
laid down by Dr. Jenner§ will prevent this source of error, 
time had nearly prevented the introduction of this valuable 

produced a perfect disease In a child of one year old ; whereas with 
matter taken the next (or eighth) day of the disease, when its ap- 
pearance was still more beautiful and its size augmented, I induced a 
spurious pustule on my own hand, which was from the beginning at- 
tended with an intolerable itching ; a light areola of nearly three- 
fourths of an inch diameter occurred on the fourth day, accompanied 
with a hard base. On the fifth a fluid of a purulent nature gave the 
pustule more of a Variolous appearance and by the seventh day a scab 
was forming ; the whole was nearly gone by the twelfth. Here was 
a pustule differing from those I had formerly experienced in my own 
person, as light from darkness ; it wanted the flat surface and depres- 
sed centre and was unaccompanied with any febrile indisposition or 
axillary affection which existed in the perfect disease. 
§ Treatise on the Variolse Vaccina?, p. 78. 



9i 

Matter possessing the specific virus, originally, may by 
Suffering a decomposition, from too great heat, from putre- 
faction, or from any other cause, prove a source of the spu- 
rious disease.* Matter may be taken at too late a period from 
the true pustule when it has totally lost its specific property. 
On all these heads, I must refer to Dr. Jenner p. 72 et 
seq. and shall here content myself, with giving a valuable 
and concise view of the genuine and spurious pustule, in 
Dr. Jenner's " Instructions for Vaccine Inoculation," which 
I lately received from England, and which have already been 
published in the news-papers. 



" INSTRUCTIONS FOR 

" VACCINE INOCULATION. 

" LET the Vaccine fluid be taken, for the purpose of 
inoculation, from a pustule that is making its progress regu- 
larly, and which possesses the true Vaccine character, on 
any day from the fifth to the eighth, or even a day or two 
later, provided the efflorescence be not then formed around 
it. When the efflorescence is formed, it is always most 
prudent to desist from taking any more of the virus from 
that pustule. 

" To obtain the virus, let the edges of the pustule be 
gently punctured with a lancet in several points. It will 
gradually ooze out, and should be inserted upon the arm a- 
bout midway between the shoulder and the elbow, either by 
means of a very slight scratch, not exceeding the eighth 
part of an inch, or a very small oblique puncture. 

* See the letters in the Appendix, relative to the spurious disease in 
New York, Norfolk, &c. From what cause the matter employed 
in these places, lost its characteristic property, is impossible to say. 
I hope the introduction of these letters will serve as beacons to prevent 
similar misfortunes elsewhere, by inducing Practitioners to acquaint 
themselves minutely with the character of the genuine Vaccine pock. 



9 2 

" A little red spot will appear on the punctured part on 
the third day, if the operation succeed, which on the fourth 
or fifth becomes perceptibly vesicated. It goes on increas- 
ing till the tenth day, when it is generally surrounded by a 
rose-coloured efflorescence, which remains nearly stationary 
for a day or two. The efflorescence then fades away, and 
the pustule is gradually converted into a hard glossy scab r 
of a dark mahogany colour. These progressive stages of 
the pustule are commonly completed in sixteen or seventeen 
days. 

" A single pustule is sufficient to secure the constitution 
from the Small-pox ; but as we are not always certain the 
puncture may take effect, it will be prudent to inoculate in 
both arms, or to make two punctures in the same arm, a- 
bout an inch and a half asunder, except in very early infan- 
cy, when there is a great susceptibility of local irritation. 

" If the efflorescence surrounding the pustule should be 
extensive, and occasion much local heat upon the arm, it 
may be cooled by the repeated application of pieces of fold- 
ed linen dipped in cold water; or still more expeditiously by 
a strong solution o{ the aqua lythargyri acelaii % in water; 
an ounce, for example, of the former in five or six of the 
latter. 

"If the scab should at any time be prematurely rubbed 
off, the part may be occasionally touched with the undiluted 
aqua lythargyri acetati. 

" Vaccine virus, taken from a pustule, and inserted im- 
mediately in its fluid state, is preferable to that which has 
been previously dried; but as it is not always practicable to 
obtain it in this state, we are compelled to seek for some 
mode of preserving it. Various means have been suggest- 
ed, but from the test of long experience it may be asserted, 
that preserving it between two plates of glass is the most 
eligible. Let a piece of common window-glass be cut into 
squares of about an inch each, so that they shall lie smooth 

* Goulard's extract of Saturn. 



93 

when placed upon each other. Let the collected Vaccine 
fluid be confined to a small spot (about the size of a split 
pea) , upon the centre of one of these glasses ; which should 
be suffered to dry in the common heat of the atmosphere, 
without exposure to the heat of fire or the sun. When 
dry, it should be immediately secured by placing over it the 
other piece of glass. Nothing more is necessary for its 
preservation than wrapping it in clean writing paper. 

" The virus, thus preserved, when wanted for the pur- 
pose of inoculation, may easily be restored to its fluid state 
by dissolving it in a small portion of cold water, taken up 
on the point of a lancet. It may then be used in the same 
manner as when just taken from a pustule. 

" The Vaccine fluid is liable, from causes apparently tri- 
fling, to undergo a decomposition. In this state it some- 
times produces what has been denominated the spurious pus- 
tule ; that is, a pustule, or an appearance on the arm not 
possessing the characteristic marks of the genuine pustule. 
Anomalies, assuming different forms, may be excited, ac- 
cording to the qualities of the virus applied, or the state of 
the person inoculated; but by far the most frequent variety, 
or deviation from the perfect pustule, is that which arrives 
at maturity, and finishes its progress much within the time 
limited by the true. Its commencement is marked by a 
troublesome itching ; and it throws out a premature efflores- 
cence, sometimes extensive, but seldom circumscribed, or 
of so vivid a tint as that which surrounds the pustule com- 
pletely organized ; and (which is more characteristic of its 
degeneracy than the other symptoms) it appears more like a 
common festering produced by a thorn, or any other small 
extraneous body sticking in the skin, than a pustule excited 
by the Vaccine virus. It is generally of a straw colour; 
and when punctured, instead of that colourless, transparent 
fluid of the perfect pustule, its contents are found to be o- 
paque. That deviation from' the common character of the 
pustule, arising from Vaccine virus which has been previ- 
ously exposed to a degree of heat capable of decomposing 



94 

it, is very different, in this instance, it begins with a creep- 
ing scab, of a pale brown or amber colour; making a long 
and slow progress, and sometimes going through its course 
without any perceptible efflorescence. Its edges are com- 
monly elevated, and aiford, on being punctured, a limpid 
fluid. 

** A little practice in Vaccine inoculation, attentively con- 
ducted, impresses on the mind the perfect character of the 
Vaccine pustule ; therefore, when a deviation arises, of 
whatever kind it may be, common prudence points out the 
necessity of re-inoculation, first, with Vaccine virus of the 
most active kind, and secondly, should this be ineffectual, 
with Variolous virus. But if the constitution shews an in- 
susceptibility of one, it commonly does of the other. 

" When any constitutional symptoms occur in inocula- 
ted Cow-pox, they are commonly first perceptible (especi- 
ally in children) on the fourth or fifth day. They appear 
again, and sometimes in adults, not unlike a mild attack 
from inoculated Small-pox, on the eighth, ninth, or tenth 
day. The former arise from the general effects of the 
virus on the habit, the latter from the irritation of the 
pustule. 

" If the effluvia of the Small-pox have been received into 
the habit previously to the inoculation of the Vaccine virus, 
the Vaccine inoculation will not always be found to stop 
its progress, although the pustule may make its advances 
without interruption. 

*' The lancet used for inoculation should always be perfect- 
ly clean. After each puncture, it is proper to dip it into 
water, and wipe it dry. 

" The preservation of Vaccine virus upon a lancet, beyond 
the period of a few days, should never be attempted ; as it 
is so apt to produce rust, which will decompose it. 

" EDWARD JENNER." 

Inattention to the distinction between the true and spu- 
rious Cow-pox has produced much confusion, and for a 



95 

disease. Time has however unfolded more accurately this 
difference ; and I feel persuaded, no doubt can arise in the 
mind of one who has seen the regular progress of this 
beautiful pustule : Wherever this regularity is deficient, pru- 
dence I think would induce another trial. The Small-pox 
is doubtless capable in like manner of producing a spurious 
disease: it is in this manner I would account for persons 
who have taken the disease in a natural way, after sup- 
posing themselves secured, in consequence of a violent de- 
gree of fever accompanying the sore arm produced by- 
inoculation. An eschar may be produced by any sore 
which can destroy the cutis ; this therefore though supposed 
so by many is not a criterion of the genuine nature of the 
previous Small-pox. 

But after all I have said, I have no doubt that occasi- 
onally, instances do occur of a second attack of Small-pox, 
not merely local, or even accompanied by general irrita- 
tion of the system as the effect of the local affection ; but of 
an absolute second attack. Why a person should (generally) 
escape a second attack of this and other contagious diseases, 
even though he should arrive to the great age of one hundred 
years, is a circumstance, of which we are likely always to re- 
main in ignorance. In that long period we might reasonably 
imagine a total renovation of every part of the body, by 
absorption, &c. yet the disposition impressed by a first at- 
tack, still exists ; which whilst it manifests the Power, ex- 
hibits also strongly, the Benevolence of the great au- 
thor of our existence. 

In proof of the certainty of a second attack of Small- 
pox, I beg leave to offer the following cases. 

At p. 58, Mr. Ring says, " One case where the Small- 
pox occurred a second time, I lately shewed to Dr. Jenner 
and Mr. Simpson. It was brought to me by my friend 
Mr. Leighton. To those who know that gentleman, his 
pwn opinion is sufficient ; but if any other can be deemed 
necessary, it was the opinion of all who saw the case, that 
if was undoubtedly the Small-pox. 



9 6 

9 The number of pustules amounted to some hundreds. 
Yet the patient had been inoculated by Mr. Leighton three 
years before ; and had a proper inflammation and pustule 
on the arm, together with a small eruption." 

Dr. Jenner at p. 113, on the authority of Mr. Fewster, 
gives a pretty remarkable case, of a child of fourteen months 
being inoculated for the Small-pox, which took effect very 
favorably. The nurse twenty-four years of age, many 
years before had the natural Small-pox, and was much 
pitted. She had accustomed the child to sleep on her left 
arm, with her left cheek in contact with his face, in which 
manner he mostly slept during inoculation. About a week 
after the child was well, a plentiful eruption broke out on 
the left Cheek of the nurse, but not on any other part of 
the body, and went on to maturation. Three days pre- 
ceding the eruption she had slight chilly fits, head-ach, 
pain of limbs, and some fever. The pains went off, on the 
eruption taking place, and on the fifth day, Mr. Fewster 
inoculated two children from these pustules, producing a 
plentiful eruption*. 

The circumstance of the fever preceding the eruption 
seems to indicate something more than a mere local disease. 
1 shall however in the concise manner of Dr. Jenner, tran- 
scribe the case of Mr. Richard Langford, recorded by Mr. 
Edward Withers in the fourth volume of the Memoirs of 
the Medical Society of London, to which I must refer 
whoever wishes more extensive information of the case. 

" Mr. Richard Langford, a farmer of West Shefford, in 
this county, (Berks), about fiftv years of age, when about 
a month old, had the Small-pox at a time when three others 
of the family had the same disease, one of whom, a servant 
man, died of it. Mr. Langford's countenance was strongly 

* This fever, Sec. it is evident, was not owing to the irritation ari- 
sing from the pustules, as they had not then appeared. It was there- 
fore certainly the constitutional effect arising from the primary action, 
ef the Variolous poison, 



97 

indicative of the malignity of the distemper, his face being 
so remarkably pitted and seamed, as to attract the notice of 
all who saw him, so that no one could entertain a doubt 
of his having had that disease in a most inveterate manner." 
Mr. Withers proceeds to state " that Mr. Langford was 
seized a second time, had a bad confluent Small-pox, and 
died on the twenty-first day from the seizure ; and that four 
of the family, as also a sister of the patient's, to whom the 
disease was conveyed by her son's visiting his uncle, falling 
down with the Small-pox, fully satisfied the country with 
regard to the nature of the disease. The sister died. The 
case was thought so extraordinary as to induce the Rector 
to have it recorded in the parish register.'* 

At p. 178, Dr. Jenner gives us a letter from Mr. Tho- 
mas Miles, relating his own case, as exemplifying the opi- 
nion of the frequent susceptibility of the system to the 
Variolous contagion, although it has previously felt its in- 
fluence. This gentleman being solicitous to shew the 
mode of communicating the disease by inoculation to a 
mother whose child was about to undergo the operation, 
introduced his lancet in the usual way on his own hand, 
and thought no more of it till a sensation in the part on 
the third day, reminded him of it. It proceeded regularly, 
and the pock gradually filled with a fluid, without giv- 
ing him any uneasiness, supposing a mere local affectipn 
would be the whole he should experience. In this how- 
ever he was mistaken, " for on the eighth day," he adds, 
" I was seized with all the symptoms of the eruptive fever, 
but in a much more violent degree than when I was before 
inoculated, which was eighteen years previous to this, 
when I had a considerable number of pustules. I must 
confess I was now greatly alarmed, although I had been 
much engaged in the Small-pox, having at different times 
inoculated not less than two thousand persons. 1 was 
convinced my present indisposition proceeded from the in* 
[13] 



9 8 

sertion of the Variolous matter, and therefore anxiously 
looked for an eruption. On the tenth day I felt a very 
unpleasant sensation of stiffness and heat on each side of 
my face near my ears, and the fever began to decline. The 
affection in my face soon terminated in three or four pus- 
tules, attended with inflammation, but which did not matu- 
rate, and I was presently well." 

To these very strong cases I shall make no apology for 
adding an interesting extract of a letter, dated June 15th, 
1799, from Dr. Henry Arnott, of Hopewell Township, 
York County, Pennsylvania, to Dr. Rush, and which he 
has politely furnished me with. 

" In your Treatise on Inoculation for the Small-pox you 
alledge, that there are certainly cases where there are the 
most irrefragable proofs of the infection implanted by ino- 
culation being of a Variolous nature, where the disorder 
has been afterwards taken in the natural way ; in these 
cases, you suppose the Variolous matter produced only a 
topical or cuticular disorder, and that a fever and eruption 
seem necessary for producing some impression on the whole 
system, in order to render it ever after incapable of receiving 
an impression of a similar nature. Of the truth of this I 
was fully persuaded till last summer, in the month of July, 
when (unhappily for me) some cases occurred, which I 
confess stagger me a good deal, and have exposed me to a 
very great deal of country clamour. Permit me Sir, to lay 
the cases before you. About four years ago, I inoculated 
a young woman for the Small-pox ; on the third day the 
orifice seemed a little inflamed, the inflammation however 
went off, till about the ninth day, when it began to rise up 
in form of a pustule, at which time the girl sickened, and 
the fever continued four days, attended with the ordinary 
symptoms : about the evening of the fourth day, some pim- 
ples made their appearance here and there in different parts 
of the body, which remained until the seventh day ; some 



99 

of them filled with Variolous matter and did not disappear 
till the ninth or tenth day ; they left marks behind them 
which are still visible. From these circumstances, I was 
assured she had the Small-pox, and confidently told her so. 
Since, about the 20th of March 1798, the Small-pox has 
been epidemical in this part of the country, and in July- 
following, she was called to nurse a family who had them 
of the confluent kind in the natural way : she had scratched 
a bit of skin off the little finger of her left hand, and being 
constantly employed in opening the pustules, moving the 
patients from one part to another, washing dirty clothes, 
&c. &c. it grew up in the form of a large pustule, and in 
the course of nine days, she was attacked with the eruptive 
fever, which continued with considerable violence for four 
days, at which time, the Small-pox made their appearance 
to the amount of five hundred, the most o£ which filled 
with good matter, and continued so till the ninth day, when 
they formed into scabs, and then disappeared. 

" Another girl was attacked with the fever, which con- 
tinued the usual length of time, attended with the common 
symptoms, after which, three pimples made their appear- 
ance, and then disappeared about the ninth day. 

" Another girl in the same house seemed to have been in- 
fected by her ; she was seized with a fever, which produced 
several pustules : the first of these girls being satisfied she 
had had the Small-pox, exposed herself to the contagion, was 
infected a second time, and attacked with the confluent 
Small-pox, of which she recovered with great difficulty : 
upon the back of which, the other girl was attacked with 
the same disorder, which carried her off about the four- 
teenth day. A gentleman in this neighbourhood employed 
me to inoculate his children, seven in number-, previous to 
which, he had got a servant girl from Baltimore, who had 
been inoculated before she came to the country ; the mark 
of the orifice in her arm was perfectly visible, and she af- 
firmed she had gone through all the different stages of the 



100 

disorder : however about the time that the children were in 
a blackening state, she took the Small-pox, but got over 
pretty easily 

" Such cases are certainly distressing both to families and 
Practitioners : from these cases however, which I know to 
be incontestible facts, I am really inclined to think, that a 
person is liable to be attacked with the Small-pox more than 
once in his life," 

To these cases manv Practitioners will doubtless be able 
to add others. They certainly are very extraordinary, and 
may serve to moderate the clamour of some, who consider 
the Vaccine, as either only acting as a temporary preven- 
tive, or as by no means universally infallible. The first of 
these opinions seems sufficiently confuted, (see p. 67) ; and 
should the last be found true, (which of many hundred 
thousands has not yet been the case), it will still be in this 
respect, on an equality with the Small-pox. 

The great advantage of this extraordinary disease, is evi- 
dently its prophylactic power against the Small-pox. But 
its benefits to mankind do not cease here. Its efficacy in 
the removal of sundry diseases of a chronic nature, and 
w r hich had baffled a variety of medical applications, seems 
established by numerous testimonies. Although experi- 
ence has proved it to have worked a cure in several in- 
stances, it is not to be supposed it always will be equally 
effectual : but assuredly it deserves a trial in similar instan- 
ces which do not readily yield to the power of medicine. 
Its mildness will always be a pledge of its security ; and no 
harm can possibly arise, even though no positive good should 
ensue. 

Many Practitioners have assured us of its beneficial influ- 
ence on weakly constitutions, in repeated instances. It is 
however not uncommon to see a weakly constitution, amend- 
ed by any disease which affects the system generally; hence 
even the Small-pox will occasionally prove beneficial. I 



can add with much propriety on this point, the observation 
of a parent to me after his child had passed through the di- 
sease ; that it was not a disease for poor people ; in allusion 
to the appetite which seemed to have rapidly increased. 

It appears from the observations of Dr. jenner and others, 
that the Vaccine besides frequently benefitting weakly con- 
stitutions, has actually corrected a scrofulous diathesis ex- 
isting in the constitution. Dr. Cappe says he has seen "one 
of his patients recover from sore eyes, and eruptions on the 
skin; and three others from eruptions on the skin, while 
under inoculation of that disease," Ring, p. 370. 

Mr. Simpson's letter to Mr. Ring contains a most valua- 
ble testimony in its favor; " Mr. G 's child had a very 

obstinate eruption of the crusta-lactea kind ; but more vio- 
lent than it is commonly met with. It covered the head 
and face, and the greater part of the body. It withstood 
the effects of the usual remedies ; and the little creature was 
really disgusting to look at. The time arrived, at which, 
the parents usually had their children inoculated. I advised 
the Cow-pock; to which they at first objected, from a fear 
of aggravating the disease ; but they afterwards consented, 
when I assured them that such an event was not probable, 
and that it was not impossible it might remove it. 

" The child was inoculated with Cow-pox matter ; and 
it was extremely gratifying to me to observe, that as soon 
as the constitution was evidently affected, the disease of the 
skin began to disappear ; so that by the time when the 
Vaccine action subsided, the whole of the eruption had 
peeled off, in the form of very fine scales ; or was brushed 
off, like powder. Not a particle of medicine was given ; 
nor any external application used. I have the pleasure to 
say, there has been no return of the complaint, although 
ten months have elapsed. 

" Several instances have occurred to me, in which the 
general health of weakly children has been very much im- 
proved." Ring, p, 736, 



102 

Doctor Husson in his valuable treatise, entitled " Re- 
cherches historiques et medicales sur la Vaccine," has 
collected together a number of striking instances of its ef- 
ficacy in regard to health, as mentioned by different per- 
sons, and two strong cases which came under his own ob- 
servation. One was a case of 'violent head-ach of three 
vears standing, attacking the patient every three or four 
days, and which had baffled every effort. The Vaccine 
pustule was accompanied with a very extensive erysipelas, 
*kc. The child at the expiration of five months had had no 
return of the head ach. The other was a case of scrofu^ 
la, cough, and shortness of breath. As soon as the pus- 
tules began to appear, the cough became less frequent, 
the complexion improved, the glands of the neck dimi- 
nished; and at the time of his writing he speaks of the 
child as being quite well. See p. 51 et seq. 

Dr. Moreau, in his " Historical and Practical Treatise 
on Vaccine Inoculation," has given us a case of scrofulous 
cpthalmia cured by the Vaccine. In another instance the 
discharge from a fistula in the neighbourhood of the elbow, 
w T as lessened. The latter patient was inoculated on a sur- 
face covered with, an herpetic eruption. Others were ino- 
culated with the virus produced from this scrofulous and 
herpetic subject, without injury. See Ring, p. 792. 

Mr. Ring, p. 799, says he has seen a letter from the 
Count de la Roque, stating, that he has received informa- 
tion of the Cow-pock being a corrector of some other dis- 
orders. He mentions a severe epidemic hooping-cough, 
which they who had undergone Vaccination, either escaped 
altogether, or had it mildly. This I suspect to be only an 
accidental coincidence. Mr. Fournier, first surgeon to the 
Military hospitals at Brussels, in a treatise on this disease, 
gives the following fact, which was certified by citizen 
Lebroussart, Professor of ancient languages in the Central 
School, *' One of his children, four years of age, was a 



ioj 

Jong time affected with deafness, which grew worse arid 
worse. Two months ago he was inoculated with the 
Cow-pock. On the ninth or tenth day, when the arm in- 
flamed, the deafness began to diminish, and on the twenty- 
first it entirely ceased." See Ring, p. 855. 

Mr. Ring further states from a communication of Mr. 
Garsed, that an infant four months old had been troubled 
with a violent cough about three months, which did not 
yield to medicine. The fifth day after Vaccination the 
cough suddenly left her, and did not again return. Mr. 
Garsed also informed Mr. Ring, that Messrs. Jones and 
Powell of Neath, mentioned to him " that a boy sixteen 
months old, full of scrofulous tumours, was brought to 
them for assistance :" they supposed it could not live a 
vear. The mother laboured under the disease and had lost 
a child by it ; she died also herself shortly after, from the 
vast discharge of different scrofulous abscesses. The child 
having never had the Small-pox, was vaccinated on the 
twenty-third March 1801, the disease running its course in 
the most favourable way. At this time he had several ab- 
scesses about the arms, neck and shoulders, which soon be- 
gan to heal, and the child enjoys perfect health. All which 
was attributed to the Cow-pock. See Ring, p. 856. 

I have met with one case, in which for ten days or two 
weeks preceding Vaccination, a disagreeable eruption had 
appeared on the arms and face, attended with great itching. 
About the time the areola began its progress, this declined, 
and by the fourteenth or fifteenth day was nearly gone. 
Whether it would not have gone of itself, I cannot pretend 
to say. 

A remarkable case occurred also at Burlington, to Dr. 
Shippen, in a young lady who had had the Small-pox in 
early life, and was troubled with a disagreeable eruption, 
(which did not yield to medicine) on her face. She sub- 
mitted to Vaccination and had it very finely and perfectly; 



104 

The disease however declined, and she still I believe conti- 
nues free from it.* 

In addition to these cases, I shall add the following, given 
me by Mr. John Vaughan, and which was procured from 
the parent of the child. " Samuel Swift son of Edward 
Swift of Bustletown, Philadelphia County, born January 
3d, 1801, three weeks after birth was attacked with a 
violent eruption, chiefly of the cheeks, forehead, and chin, 
which baffled all medical applications. About January 20th , 
1802, he was vaccinated by Dr. Worthington, a chief rea- 
son for which was to try the efficacy of the case in the above 
complaint. The face was worse than ever at the time the 
Vaccine was at its height. As the arm healed, the face grew 
better, and he now continues well ; at times in cool weather, 
a little redness but no eruption has been perceptible." 

I might go on to accumulate cases, but I apprehend these 
are sufficient to awaken attention on this point; and surely 
the subject deserves it. By Females it certainly deserves to 
be tried, since in many instances, the most pernicious appli- 
cations are employed without effect, to remove those erupti- 
ons which frequently take place on the face and neck. It 
is to be observed I speak only of such chronic cases, which 
have baffled every application. In those only would I wish 
to recommend it. Experience however will daily augment 
our knowledge on this point, and I sincerely hope its truth 
may be confirmed. 

It will not be improper here to give a comparative view 
of the superiority of the Vaccine over the Small-pox, in 
order to confirm the friends of this disease in their estimati- 
on of it, and in hopes to awaken conviction in the minds of 
its opponents. 

* I was in hopes to have had it in ray power to detail this case ; I 
wrote to Dr. S. for the particulars, but have not yet received an answer. 
I have met with a case of almost constant head-ach since birth, which 
I vaccinated a short time past, since which there has been no return. 
Time must determine if the effect is permanent. 



io5 



COMPARATIVE VIEW OF THE 

Vaccine and Small-pox. 



Small-pox. 

First. This disease is in 
the highest degree contagi- 
ous: hence those who never 
have had it, cannot without 
extreme hazard, mix with 
such as labour under it. 

Second. The eruptive fe- 
ver of the Small-pox is not 
unfrequently attended by con- 
vulsions of the most alarming 
nature, the effects of which 
are often felt through life; 
This is even often the case 
when the subsequent erupti- 
on is comparatively small. 

Third. The numerous 
pustules produced by this di- 
sease in many instances, in 
opposition to every attention, 
whilst they exhibit by their 
temporary presence, a sight 
of the most horrid kind ; are 
not less to be dreaded from 
their frequent disfiguration of 
their unfortunate victim, by 
the pits they leave behind. 

Fourth. That attention to 
diet and to medicine, which 
is often necessary in guarding 
against the violence of this 
terrible disorder, is a frequent 
source of evil, as hundreds of 
mothers can testify. 

[ 14 ] 



Vaccine. 
As this disease is not con- 
tagious, the separation of the 
well from those who are un- 
der its influence is entirely 
needless. 

None of these dire effects 
are to be dreaded in the mild 
process of Vaccination. 



An eruption in this disease 
is so rare an occurrence as 
never to be expected : And 
where it does exist, the num- 
ber is so small, as to render 
it of little moment. 



There seems to be scarce- 
ly an instance in which either 
regimen or physic would be 
requisite in the Vaccine. 



io6 



Small-pox. 

Fifth. The season must 
be attended to in inoculating 
for the Small-pox ; as well 
as the age and present condi- 
tion of* the system ; hence 
pregnancy and teething are 
invincible barriers against in- 
oculation. 

Sixth. The frequent, and 
often long continued nursing; 
the extreme anxiety which all 
parents must feel, although 
every precaution be made use 
of, because the issue of the 
disease is at all events preca- 
rious, must forcibly contrast 
the two diseases. 

Seventh. The Small-pox, 
it is agreed, often calls into 
existence the dormant germs 
' of disease, or so alters the 
constitution of the patient, 
that it more readily receives 
such impressions, as dispose 
to various diseases, as scro- 
fula, white swellings, con- 
sumption, opthalmia, blind- 
ness, and many more. 



Vaccine. 
One season is scarcely pre- 
ferable to another in this mild 
disease : Age and existing cir- 
cumstances are of little mo- 
ment; hence teething and 
pregnancy are no objections 
to its use. 

Nursing, anxiety and death 
are almost equally strangers 
to the Vaccine. Death, we 
may confidently affirm, has 
never employed the Vaccine 
as a besom of destruction. 



As much as we know of 
the Vaccine, we find it effi- 
cacious in frequently remo- 
ving many formidable com- 
plaints, and in benefitting a 
weakly constitution. 



The comparison might probably be considerably extend- 
ed : enough is said however, to shew the vast superiority 
of the Vaccine over Variolous inoculation. 



I cannot bring this treatise to a conclusion without re- 
marking, that as it is of infinite consequence to mankind, to 
determine accurately, if the Vaccine originates in the Grease 



107 

of the horse, I hope it will induce persons who have lei- 
sure and opportunity to attend to such investigations, to ex- 
periment fully on this important point. This is a work of 
greater facility in the country than in the town. I have in 
vain endeavoured for several weeks, to procure the matter of 
the Grease from the inns and livery stables of this city, and 
from other sources, where I thought I might be likely to 
obtain it. My wish was to inoculate a cow, and also to try 
to produce the specific disease on myself with it, and from 
this source to transplant it to another, in order to determine, 
whether the passage of this matter through the human sys- 
tem would not produce a disease perfectly similar in appear- 
ance and effects. It appears probable from the eighteenth 
case mentioned by Dr. Jenner, and to which I have already 
referred, see p. 15. 

Is no other animal than the cow capable of perfecting 
this invaluable Prophylactic ? What effect would take place 
by inoculating the dog, sheep, &c. with the matter of 
Grease, and also of the Vaccine? If the Vaccine is produ- 
ced by the Grease originally, what would be the effect of 
Vaccinating a horse ? Is he capable of keeping up the true 
infection in this manner as the cow; and what effect would 
the matter of Grease itself have on the horse by inoculation? j| 

It has been asserted that the Cow-pox had been discover- 
ed among the American cows to the northward. In the 
Medical Repository, Volume 5, p. 93, three Physicians, 
Doctors Buel, North, and Trowbridge, acquainted Dr. Mil- 
lar with this fortunate occurrence about the same period; 
in consequence of which I addressed the following letter to 
those gentlemen. 

" Dear Sir, 

"' Will you excuse the trouble I am 
about to give you, in requesting an accurate account of the 
important discovery you have made, of the Vaccine amongst 
the American cows, as stated in the fifth volume of the Me- 

J| See the extract of Dr. Jenner's letter to Dr. Waterhouse, p. 115, 



io8 



dical Repository. I feel particularly interested in this inqui- 
ry, from having been the means of introducing it into Phi- 
ladelphia; and having collected a considerable number of 
facts on this interesting disease, I am anxious to learn every 
particular of its origin amongst us. 

" The particular points 1 wish to ascertain are, whether the 
disease has long been known ; and whether it is supposed to 
originate in the animal itself, or by transmission from some 
other? is the Grease or Scratches a common disorder among 
horses with you? Are men on large farms in the habit of 
milking the cows? And has the disease produced, always 
opposed the Small-pox? 

" An answer to these queries as early as convenient, will 
very much oblige, 

" Sir, Your Humble Servant, 

" JOHN REDMAN COXE. 
"Philadelphia, March 17, 1802." 

To this I received the following valuable and interest- 
ing communications, for which I return the gentlemen my 
very sincere thanks. 
" Sir, 

" I cheerfully attempt to answer the request 
contained in your letter of the 17th of March last, relative 
to the Vaccine disease among the American cows, discover- 
ed in this place in June, 1801. No traces of the disease 
can be discovered here, previous to the time abovemention- 
ed. It undoubtedly originated in the animals from which 
the matter was communicated to the two women who milk- 
ed them, and no other persons, either men or women ever 
milked those cows. The Grease or Scratches is not an un- 
common disease among the horse kind here, especially in 
the winter season, but I cannot discover any case of it in that 
neighbourhood at that time, or for many months previous. 

" Men are not generally in the habit of milking in our 
farms, and particularly in this family, where it is clearly 
ascertained that none but women had milked. In answer to 



your last question, viz. * has the disease produced, always 
>sed the Small-pox?' I will give a short account of its 
discovery and progress, and leave you to judge. In June 
last, my anxious researches were gratified, by discovering 
vhat I judged to be the genuine Kine-pox on the hands of 
two respectable women, a mother and her daughter in my 
neighbourhood. From those I inoculated about twenty, 
including my own family, in the months of July and Au- 
gust. People's prejudices were hard to overcome, and so 
few applied that I lost the matter, but soon found that the 
children were for mere pastime inoculating one another at 
school, without any guide, excepting a small caution which 
I received from Dr. Waterhouse, and published, viz. ■' ne- 
ver to take matter for inoculation after the eighth day.' On 
the 9th of December last I inoculated Mr. Lemuel Taylor 
and ten children, in consequence 6f Mrs. Taylor having 
broke out that day with the Natural Small-pox. The whole 
of this family took the Small-pox from this first inoculation, 
exceptingrfour of his eldest children, who had received the 
Vaccine disease about five or six weeks previous. This wo- 
man .had the confluent pock to an alarming degree; the 
whole family attended her throughout (excepting the 
youngest, a sucking infant, which expired convulsed in 
the eruptive fever) ; the four abovementioned were inocu- 
lated with Variolous matter seven different times without 
the least effect, and yet remain so. 

" A young man aged twenty, received the Vaccine di- 
sease in July, and a little girl aged five years, also received 
it in January ; both have been thoroughly inoculated with 
Small-pox by a neighbouring Physician (an unbeliever) 
without effect. Those few experiments awakened the minds 
of the people to conviction, and as is usual, unlimited con- 
fidence succeeded extreme scepticism ; the Vaccine inocula- 
tion pervaded every class of citizens so generally, that of 
three thousand three hundred inhabitants contained in the 
town, two thousand at least are judged to have received it: 
pf those, fifty or sixty may be found who have from vari* 



no 

©us motives, repeatedly visited the different Small-pox hos- 
pitals, with indifference, yet no one has yet taken the dis- 
ease. I shall be very happy to hear of its success, or anv 
unfavourable appearances that may happen in Philadelphia, 
or elsewhere: At present my faith in the utility of this new 
disease is unimpaired, but should it prove fallacious, I think 
the public have a right to the earliest information. 
" With sentiments of respect, 
" I am your humble servant, 

« JOSEPH TROWBRIDGE. 
es Banbury, April 1th, 1802." 

" Sheffield, \5th April, 1802. 

"Doctor John Redman Coxe, 
M Sir, 

" I delayed replying to your favour 
of the 17th ultimo, that I might communicate some facts 
in relation to the subject of domestic Kine-pox, which, at 
the time of my receiving your favour, wanted time to de- 
velope. 

" That the genuine Vaccine-pock has been derived from 
cows in one or more instances in my neighbourhood, is a 
fact, the truth of which I do not myself in the least doubt. 
The evidence on which my belief is founded I will attempt 
to detail to you in a brief and circumstantial manner. I 
was requested in the month of March, 1801, to visit a son 
of Colonel Joseph Goodrich, who I was informed was 
affected with sores or boils of peculiar appearance. I 
found him with several tumors upon his face and hands 
of the size of large boils, but flat upon the apex of each 
to the extent of a half dime piece, and having underneath, 
a small quantity of an almost colourless fluid. I was at 
once struck with the singularity of the appearance of these 
tumors. I had at that time a few patients under my care, 
whom I had caused to have the Kine-pox by inoculation; it 
occurred to me that the tumors resembled Kine-pox, but 
they were considerably larger and more prominent than 



Ill 

any I had seen In that disease. At my visit the next day, I 
strongly suspected the identity of his disease and Kine-pox, 
and that it was dissimilar to any thing else. I requested 
permission of the Colonel to inoculate some of his family 
with matter from the tumors, and others with Kine-pox 
matter, which I had in my possession, which was accord- 
ingly done. In two (which if my recollection serves me 
were all who received infection from the boy), the parts 
inoculated soon began to inflame, as in Kine-pox, and about 
the eighth day they had pyrexial symptoms. The progress 
was similar in one of those who received Kine-pox mat- 
ter. Hie tumors were larger, the local inflammation more 
extensive, and the symptoms all more violent, in those ino- 
culated from the boy than in the other person. One of 
those in particular had much local inflammation which 
continued several days, followed with the sloughing off of 
a sufficient quantity of substance to leave a pretty deep 
seated ulcer. The ulcer however, after digestion took place, 
•healed kindly. I was now satisfied for myself that I had dis- 
covered the Vaccine-pock. It now remained that the man- 
ner in which the boy obtained it should be investigated. 
The Colonel I well knew kept a large number of cows: 
upon enquiry I found, that his soniiad been in the prac- 
tice of milking them, and that it was recollected by the 
boy and others of the family, that one of the cows had 
been affected with sores upon her teats. It was also well 
remembered, that this boy a few days before the com- 
mencement of his disease, had in play with his compani- 
ons, received several scratches upon his face and hands. 
Into these lacerations it is not improbable that matter from 
the cows (taken upon the hands, and they accidentally ap- 
plied to the face) might have been insinuated, and in this 
way a complete inoculation come to be effected. 

" In about three weeks from the time when those whom 
I had inoculated in this family were diseased, I inserted 
into the arm of one of those who had been inoculated 
from the bov, and into that of the one who had had Kine- 



112 



pox otherwise, some good Variolous matter which had been 
taken, the day before, from a person in Smail-pox, but 
with no other effect in either, than a little inflammation of 
the part, which subsided in five or six days. This I 
thought pretty satisfactory evidence, that my domestic 
Vaccine disease was a preventive of Small-pox. I regret 
that experiments with this matter were not repeated while 
the matter which I had saved was active. But owing part- 
ly to a press of other avocations, and partly to the difficulty 
of obtaining subjects for experiment, the business was not 
prosecuted until the matter had lost its activity. 

" Fourteen days since (which is the circumstance that 
caused my delay in replying to your queries), I inoculated 
the whole four of my abovementioned patients with Vario- 
lous matter without effect. The matter was unquestion- 
ably good, and the insertion faithfully performed. I shall 
not swell this epistle with comments, but attend to your 
query with regard to the origin of the disease in the cow. 
My own mind with regard to the origin of the disease in' 
this case, as well as to the general principle, is in suspense. 
There is an air of improbability in the theory of the origin 
of the Vaccine disease from the heels of the horse, that I 
cannot get over. But to well authenticated facts I ought, 
as I hope I ever shall, yield conviction. Facts of this 
kind sufficient to establish the theory, I do not know that 
we are yet in possession of; circumstances in the case which 
1 have related were not unfavorable to the truth of the 
theory. The Colonel had a large number of horses, and 
some of them I was informed, were affected with the 
Grease in the heels ; the same persons also who milked 
the cows dressed the heels of the horses. The disease 
therefore might have originated in this way. 

"I will just add that I have no doubt in my own mind, 
but that the Vaccine disease, was, in the course of the win- 
ter before last, derived from cows to the human species in 
two other families in this town. Several persons I be- 
lieve had the true disease. But as the facts did not come 



under my own observation, and as no experiments have 
been made on them with Variolous matter, I shall not 
swell this communication, already protracted beyond my 
expectation, with any particulars. 

" There have been inoculated* by me, and under my 
inspection, in this town, about fifty patients, who have had 
the Vaccine disease in a mild manner, and about half of them 
have been tested with Variolous matter without effect in 
any instance. 

" Should you wish Sir for any further information from 
me, in relation to this subject, I will ever cheerfully attend 
to your commands. If in the progress of your business in 
this line any new facts should occur, I will thank you to 
communicate them to me. 

** I am Sir, respectfully, 

" Your Humble Servant, 

" Wm. BUEL." 

Dr. Waterhouse, to whom I wrote on the same subj ect^ 
politely furnished me with the following reply. It com- 
mences the letter from which I have given an extract at 
p. 70. 
" Dear Sir, 

'* Your letter of the 17th instant came to my hands last 
evening. In answer to your query respecting the indige- 
nous, or domestic origin of the Vaccine disease, I must in- 
form you that I have my doubts. I had early information 
from Drs. Buel, Trowbridge, and if I mistake not from 
Dr. North, on that subject. The matter sent me by the 
first never produced the disease, although the thread was as 
stiff as a wire with it: that was however no proof that it 
was not genuine. I have had information from perhaps a 
dozen quarters respecting this disorder among our cows; 
one was to me so un-equivocal, that I wrote to Dr. Jenner 

* The necessity of employing the term Vaccination in contradis- 
tinction to Inoculation will I hope soon be generally admitted. 
[ 15 ] 



ii4 

that we had certainly found it among the American Line ; 
you will see however, in the London Medical and Physical 
journal for September, that we were deceived. A young 
woman at Dorchester in the county of Norfolk, had an e- 
-ruptive disease which she caught by milking a cow whose 
udder was covered with pustules ; this person had a severe- 
febrile affection, and painful pustules on her hands and arms ; 
she was therefore sent into the Small-pox hospital and took 
the Small-pox from inoculation. I doubt not the accuracy, 
much less the veracity of these Practitioners, but suspect they 
have been deceived in a way similar to that I have related 
in the Medical journal, under the communication respect- 
ing " the effects of heat on the virus." Medical pupils 
and others have slyly inoculated cows, merely for the sake 
of the experiment, or for a supply of matter. I inoculated 
one of my cows for that purpose and succeeded to my wish. 
That the Cow-pox has arisen spontaneously (if a person may 
use that term who believes, that strictly speaking, there is no 
such thing in nature) in the kine of our country is a matter 
of which I am far from being entirely satisfied. I shall not 
therefore cease a rigid enquiry relative to the domestic ori- 
gin of this distemper." 

If the disease whose history is recorded by Dr. Trow- 
bridge, was really the genuine Cow-pox, and of this there 
scarcely seems a doubt, how can we account for its producti- 
on where there appears no vestige of the Grease ? This must 
require the strictest attention to determine, as it will tend to 
prove the origin of the disease to be in the cow herself, or 
else that there has been some other source of communicati- 
on from the horse. It is not impossible to suppose a cow to 
take this disease from the matter of the Grease, even though 
we cannot trace it to its source from the horse through the 
hands of a man who may have previously dressed the diseas- 
ed heels. The matter of Grease or Scratches is a limpid 
fluid oozing from the cracks of the heels, and from thence 
consequently, must not unfrequently fall down upon, or be 
brushed off, by the herbage of the field in which the animal 



"5 

may be feeding. Whilst still fluid upon the grass, we may 
easily imagine a cow might accidentally lay down in this 
very spot, so that her teats and udder should come in imme- 
diate contact with the infection, and thus by a species of 
inoculation produce the disease. There are many things of 
whose truth we are certain, which appear far more impro- 
bable. Some persons have supposed the disease could not 
originate from the horse, because it could not be traced com- 
pletely in every instance, through the hands of men employ- 
ed to milk. I think this mode of accounting for it may 
serve to reconcile these opponents.*' 

I hope these and the subsequent valuable communications 
will influence Practitioners to pay attention to the subject, in 
hopes of discovering the disease nearer at home. Dr. Jen- 
ner's idea that the virus, is as perfect in its Equine as in its 
Vaccine state at its first formation, is of the utmost import- 
ance, and will certainly meet with the attention it deserves, 
from every one disposed to forward his philanthropic views* 

T shall here introduce the following important commu- 
nication from Dr. Jenner to Dr. Waterhouse which he has 
very politely forwarded to me, 

Cambridge, May 26th, 1802, 
" Dear Sir, 

" I am induced to write to }K)u at 
this time to give you a short extract of a letter from the 
worthy jenner, which I received not long since, respecting 
a new source of the Vaccine virus, not knowing but what 
you would wish to insert it in your publication. It is this; 
" ' I have sent you- also some virus from a new stock. 
6 The old stock now in use near three years, has not lost 

* If the Grease does not give origin to the Vaccine j it certainly 
seems to depend upon some common cause, with this last disease} the 
fame season and kind of weather disposing to both. 



u6 



; any of it's original properties, nor do I suppose it ever 

* will. A medical gentleman at Milan, Dr. Sacco, (who 
f informs me he has inoculated 8,000 persons in that city), 
f has lately sent me Vaccine virus taken from a dairv on the 
' plains of Lombardy. It has produced again and again 
4 the perfect pustule here. I always ventured to predict that 

* the Cow-pox was not confined to this island, but that 
e wherever, in the same dairy, there should happen to be 
' the peculiar intercourse I have pointed out between the 

* horse, the man, the cow, and the milker, that there the 
' disease may be called into existence. Abundant testimonies 
6 of the source of the Vaccine virus have lately appeared, and 
' I have long been convinced that it is as perfect in all its ex- 

* traordinary qualities in it's Equine as in its Vaccine state ; 
c perfect on it's first formation, and imperfect when secreted 
' at a late period of the disease; just as it is, when transfer- 
c red, and subjected to go through it's progressive stages in 

* the human body.' " 

The following account of the discovery at Milan, in the 
words of Dr. Sacco himself, I shall be pardoned for intro- 
ducing in this place. It is extracted from the Philosophi- 
cal Magazine, No. 46, for March 1302, page 184. 

t{ < In our last we mentioned that Dr. Sacco, of Milan, 
had sent to Dr. Pearson, Cow-pox matter, taken from the 
Milanese cows. In a work published by Dr. Sacco, in 
Italian, entitled ' Practical Observations on the Use of the 
Cow-pock, as a Preservative against the Small-pox,' he 
gives the following account of the manner in which he 
procured the pus for inoculation, and also a representation 
of a cow's udder infected with the malady. 

" For some time I had been extremely desirous to repeat 
the experiments of Jenner, and for this purpose made dili- 
gent search to discover the Cow-pox in Lombardy, it beings 
extremely difficult, especially in the present circumstances, 
Xq obtain the pus from England. A fortunate combination 



ii7 

of circumstances, by which it became necessary for me to 
go to the large town of Varese, in the beginning of autumn^ 
procured me an opportunity of examining a number of cows 
on their way from Switzerland to the fair of Lugano; and 
by this means, I had a favorable opportunity to make such 
researches, as might discover in some one of them the Cow- 
pox. It was on this occasion, that, conversing with some 
dealers in cattle, and countrymen who had large dairies in 
Lower Lombard y, I learnt that the cows among us are sub- 
ject to the Cow-pox. In this inquiry I took care to propose 
my questions in such a manner as to prevent the risk of be- 
ing imposed upon. A farmer of Cremona, who had bought 
forty cows in Switzerland, and had driven them from thence 
as far as Varese, assured me, that almost all of them had 
been successively attacked with pustules on the extremity of 
their nipples, and some of these were now converted into 
incrustations. I visited the cows, and had an opportunity 
of verifying his assertions. 1 picked off some of these in- 
crustations with an intention of applying them in fomenta- 
tion, if, perchance, 1 could not procure the true pus for 
inoculation. The same farmer promised me an opportunity 
of seeing this disease with my own eyes, and for this purpose 
conducted me to a neighbouring meadow, in which we found 
a herd of cows belonging to a friend of his. We examin- 
ed these cows, and discovered on two of them different red 
spots, which the farmer assured me was the first stage of 
the disease ; no other symptom appeared on the cows, but 
a slight degree of dejection. He assured me that this was 
the very disease I was in quest of, and that, in the course 
of two days, the pustules would unfold themselves. At 
this visit which I made to the cows, there was present a 
dealer in the Orison's cows, who fully confirmed the truth, 
of these assertions. He also added, that in his country, he 
had seen the cows affiicted with a similar eruption on their 
dugs, and to remove the incrustations, it was common to 
anoint them, with boiled oil used for varnish; and that bf 



n8 



this means thev Fell off in the course of two or three days. 
Early next morning I went again to see the cows, examined 
them anew, and found on one of them four red spots, alrea- 
dy tumid and raised into pustules ; three of these were spread 
over the nippies, and the fourth lay in the middle of the 
dugs. The other cow had six pustules ; two on the nipples 
and the rest scattered above them. These were larger than 
those of the first cow, and around them appeared a slight 
red circle. Apparently these pustules occasioned much pain 
to the cow, for, on my approaching to examine them more 
minutely, they would scarcely permit me to touch them for 
one moment. Although the pustules were already large 
and prominent, they did not yet appear to me sufficiently 
mature to yield the matter I wanted. As the cows were 
that day to go forward on their way to Milan, I found my- 
self under the necessity of following them to their first halt- 
ing-place, in order to examine them again next day. I 
walked out at an earlv hour to the meadow where they were 
at pasture, I examined the pustules, which appeared to me 
to be now arrived at maturity. They were lucid, and of a 
pale red colour, with a brown spot in the middle more de- 
pressed; and I thought this a favorable moment to collect 
the matter, which, through the assistance of the herdsmen, 
I was easily enabled to do by repeatedly soaking a thread in 
it. Although I saw no reason to doubt that this was the true 
Cow-pox, yet, this being the first time 1 had ever seen it, 
I began to suspect, that the pustules might be of that kind 
which Jenner calls the spurious Cow-pox. I determined, 
therefore to decide the matter by experiment. A consider- 
able number of experiments, all uniform in their symptoms 
and progress, and always constant in theit results, put the 
matter beyond doubt, and gave me full conviction that this 
was the true Cow-pox. Such and so many are the obsta- 
cles to be overcome on the introduction of any innovation, 
however salutary, that I for some time despaired of being 
gl>le to induce any one to submit to inoculation with the 



ii9 

matter I had collected. In fine, after many fruitless pet* 
suasions, 1 succeeded in my design ; the success which at- 
tended the first inoculations encouraged others to%ubmit to 
the same process. 

" Dr. Sacco then proceeds to detail three hundred cases, in 
which he applied the pus he had obtained in the manner des- 
cribed above. These cases were attended with various cir- 
cumstances ; but the inoculation succeeded to produce the 
Cow-pox in all of them ; and in a considerable number the 
inoculation for the Smail-pox was afterwards applied, but: 
without any effect."* 

As connected in some degree with the progress of Vacci- 
nation in different parts of the world, I trust it will not be 
uninteresting to give a short history of its introduction into 
tills metropolis. 

Having perused with much satisfaction Dr. Jenner's trea- 
tise on the " Variolar Vaccinas," together with some of the 
various periodical publications on the same subject about the 
close of 1800, I became very desirous of ascertaining the 
truth of so extraordinary a discovery. My desire was how- 
ever checked by learning through the medium of the daily 
papers, that the Small-pox bad been introduced into Mar- 
blehead, instead of the Vaccine, from which, (from my 
imperfect knowledge of the subject), I concluded the dis- 
eases were not easily discriminated. The history of this 

* It may not be amiss to mention that the pock represented on the 
infected \idder, very much resemble the pock on the hand in Dr. Jen- 
ner's first plate. They are not however coloured} and are apparent- 
ly more depressed in the centre. 

I wish we could generally fall upon some expression which might 
become general in the place of pustule. This is certainly an impro- 
per term, and the word pus, as used by Dr. Sacco and the English 
editor to imply the contents of such a vesicle, is yet more improper, 
for no such thing as pus is known in the Vaccine, except from acci- 
dental causes. The word pock will perhaps answer. 



no 

unfortunate event is minutely detailed by Doctor Water- 
house, in a communication dated February 1st. 1802, to the 
Editors of the New- York Medical Repository, and which 
has lately been published in the last Number of that valu- 
able work, Volume V, page 373, &c. This circumstance 
(with the particulars of which I was unacquainted), toge- 
ther with the introduction of a spurious disease into New- 
York, Norfolk, and other places, persuaded me it was bet- 
ter to adhere to the old mode of Variolous inoculation, 
rather than depend on a disease I considered so very uncer- 
tain. For some months 1 thought no more about it ; but 
finding by the publications from Europe, it was gaining, 
ground, and that many who at first opposed it, were now be- 
come its strenuous advocates, I resumed my favourable opi- 
nion of it, and determined if possible to procure the infection. 
Through the politeness of Doctor Bradley and Mr. Ring, I 
obtained from London, several successive portions of infec- 
tion about the end of September 1801. These failed in e- 
very instance. A subsequent portion however succeeded, 
which I received on the 13th or 14th of November. Pre-^ 
vious to this, I had fortunately obtained an infected thread 
from President Jefferson, which he kindly procured for me 
from Doctor Gantt, in consequence of my request through 
Mr. John Vaughan. The infection was accompanied with 
the following highly satisfactory letter on the subject, which 
I have the President's permission to make public. 

" Washington, November 5, 1801. 
" Dear Sir, 

" I received on the 24th ult. your 
favor of the 22d, but it is not till this day that I am enabled 
to comply with your request of forwarding some of the Vac- 
cine matter for Dr. Coxe. On my arrival at Monticello in 
July, I received from Dr. Waterhouse of Cambridge, some 
Vaccine matter taken by himself, and some which he at the 
same time received from Dr. Jenner of London. Both of 



' 



I2t 

them succeeded, and exhibited precisely the same aspect and 
affection. In the course of July and August, I inoculated 
about seventy or eighty of my own family; my sons in law 
about as many of theirs, and including our neighbours who 
wished to avail themselves of the opportunity, our whole 
experiment extended to about two hundred persons. One 
only case was attended with much fever and some delirium ; 
and two or three with sore arms which required common 
dressings. All these were from accidents too palpable to be 
ascribed to the simple disease. About one in five or six had 
slight feverish dispositions, and more perhaps had a little 
head-ach, and all of them had swellings of the axillary 
glands, which in the case of adults disabled them from la- 
bour one, two, or three days. Two or three only had from. 
two to half a dozen pustules on the inoculated arm, and no 
where else, and all the rest only the single pustule where 
the matter was inserted, something less than a coffee-bean, 
depressed in the middle, fuller at the edges, and well defi- 
ned. As far as my observations went, the most premature 
cases presented a pellucid liquor the sixth day, which con- 
tinued in. that form the sixth, seventh, and eighth days, 
when it began to thicken, appear yellowish, and to be en- 
vironed with inflammation'. The most tardy cases offered 
matter on the eighth day, which continued thin and limpid 
the eighth, ninth, and tenth days. Perceiving therefore 
that the most premature as well as the tardiest cases embra- 
ced the eighth day, I made that the constant day for taking 
matter for inoculation, say, eight times twenty-four hours 
from the hour of its previous insertion. In this way it fail- 
ed to infect in not more I think than three or four out of 
the two hundred cases. I have great confidence therefore 
that I preserved the matter genuine, and in that state brought 
it to Dr. Gantt of this place on my return, from whom I 
obtained the matter I now send you, taken yesterday, from a 
patient of the eighth day. He has observed this rule as 
well myself. In my neighbourhood we had no opportuni- 
ty of obtaining Variolous matter, to try by that test the ge- 
r 16 ] 




122 

nuineness of our Vaccine matter ; nor can any be had here, 
or Dr. Gantt would have tried it on some of those on whom 
the Vaccination has been performed. We are very anxious 
to try this experiment, forthe satisfaction of those here, and 
also those in the neighbourhood of Monticello, from whom 
the matter having been transferred, the establishment of 
its genuineness here will satisfy them.* I am therefore 
induced to ask the favor of you to send me in exchange, 
some fresh Variolous matter, so carefully taken and done 
up, as that we may rely on it ; you are sensible of the dan- 
gerous security which a trial with effete matter might induce. 
1 should add that we never changed the regimen nor occu- 
pations of those inoculated ; a smither at the anvil continu- 
ed in his place without a moment's intermission, or indispo- 
sition. Generally it gives no more of disease that a blister 
as large as a coffee-bean produced by burning would occa- 
sion. Sucking children did not take the disease from the 
inoculated mother. These I think are the most material of 
the observations I made in the limited experiment of my own 
family. In Aikin's book which I have, you will find a 
great deal more. I pray you to accept assurances of my 
esteem and respect. 

(Signed) « THOS. JEFFERSON. 
" Mr. John Vaughan." 

This letter together with the Vaccine infection, was re- 
ceived by Mr. Vaughan on the 9th of November, 1801 ; A 
day which I trust will be memorable among the citizens of 
Philadelphia, from the great benefit connected with it. I 
immediately employed the infection which Mr. Vaughan 
put into my hands on myself and four others ; although these 
last had never had the Small-pox, (which I had passed through 
in early life), my system nevertheless seemed more suscep- 
tible than their's, for I took the disease by the first attempt 
in two of three places, whilst I was necessitated to repeat 



* Iri consequence of this request, I forwarded some recent Vario- 
lous matter, but am ignorant of the result of the trials made. . 






113 

it in all the others. It has been said my disease was local; 
on this point I certainly feel myself competent to decide. I 
have in the Tables in the Appendix given the outlines of the 
case.* However this be, the matter from my arm proved 
a considerable source of infection, and either directly, or 
indirectly, has aided very extensively in propagating the di- 
sease. By the commencement of March I had supplied up- 
wards of one hundred persons with Vaccine infection, with 
most of whom I believe it succeeded; amongst these are 
Practitioners of Physic in this and the adjoining states, an4 
also in those to the southward; I have likewise forwarded 
it to the Natchez, to New Orleans, and to Martinique; 
whether it has proved successful in these places I know not. 
Whilst I sincerely thank many gentlemen for their high- 
ly important communications, I have to apologise to others 
for my apparent neglect, in not supplying them with the in- 
fection which they have written for. It frequently happen- 
ed that I received such applications when I had scarcely any 
of the infection, f and they must be sensible it would not 
have been right to have deprived myself of that small stock, 
by which I trusted I should have been able to extend the di- 
sease. 



* It affords me pleasure to be able to say, that the disease on my 
arm, though advanced to the state of a scab, was at once recognised 
by an old English farmer, (from Suffolk, now residing near Chester), 
of the name of Ashford, to whom it appeared perfectly familiar, as 
well as at the less advanced period which is represented in Dr. Jen- 
ner's first plate. This man, though he has now resided several years 
in America, told me, he remembers the efficacy of the Cow-pock in 
resisting the Variolous contagion, but knew nothing of its having been 
effected through the medium of inoculation. 

•f I have already said, that many of my experiments were made 
with infection of various dates, in order to try the extent of time du- 
ring which it retained its powers ; hence it is no wonder I frequently 
failed j this, together with the various sources of failure I have former- 
ly enumerated, will I doubt not, excuse me. 



124 

The advantages of Vaccination to the southern and seve- 
ral of the middle states, where Variolous inoculation is rare- 
ly permitted, are incalculable. The same may be said of 
Kentucky, where I am informed, there are nearly one hun- 
dred thousand persons who never have had the Small-pox. J 
The advantages of this disease are scarcely less considerable 
to some of the eastern states. 

In the army and navy it doubtless deserves the attention 
of government, inasmuch as it seldom requires any confine- 
ment, or particular regimen; so lit.Ie, I have already noti- 
ced, that in England the soldiers are not even entered on the 
sick-list in consequence of this disease. It is not long since 
I was asked for matter for the Constellation frigate, in which 
the Small-pox made its appearance after leaving the city. I 
had unfortunately at the time but little to spare ; whether 
that which I sent took effect I know not. I was informed 
by her Commander Captain Murray, that in her last cruise, 
one hundred of his crew had the Small-pox, five or six of 
whom died. I need not say how great must have been the 
anxiety and inconvenience excited thereby, nor how much 
more serious such an occurrence might prove, should a ves- 
sel thus half unnian'd, meet with an enemy. The simple 
knowledge of the fact will I trust, lead those in whose de- 
partment this is placed, to attend to the subject. 

I think it proper here to mention the great necessity of 
investigating every idle tale which is brought forward to de- 
preciate the Vaccine. I have heard of a Practitioner of this 
city having a case with so bad an arm after Vaccination, as 
to make it expedient to amputate it; whereas this gentleman 
had not experienced the slightest inconvenience on this score. 
In another instance the Small-pox was said to have appear- 
ed after Vaccination. So far the story was true, but it was 

% I regret I have it not in my power to give any account of a disease 
afnong the cows in some parts of Kentucky, which Dr. Brown in- 
formed me he had reascn to believe was the genuine Cow-pox, and 
the particulars of which he promised to transmit. I have not yet re- 
ceived them. 



125 

not added that the child had never taken the disease, and 
was therefore inoculated to preserve it from the Small-pox 
which was in the neighbourhood. This was to be detected 
only by strict investigation ! Such are the falsehoods which 
impede the progress of the brightest discovery which has 
ever been made ! But the contest is in vain ! Time has 
drawn aside the veil which obstructed our knowledge of this 
invaluable blessing ; and in the examples of the Emperor of 
Constantinople,* of the Dowager Empress of Russia, § and 
the King of Spain, we may date the downfal of further op- 
position. 

I have thus brought to a conclusion the relation of the facts 
which have come under my notice, and have endeavoured 
faithfully to detail the result of my experience in the Vaccine 
from its first introduction to the present period. Most of the 
facts stated, I have myself observed, and have onlv to add, that 
I have never depended upon my memory, but have each day 
committed to paper every circumstance which appeared de- 
serving of notice, of those cases w r hich have come under my 
care. The infection when taken was always noted, both 
from whom I obtained it, and also the day of the month, 
and of the disease, so that I can trace to its origin almost e- 
very portion of matter, which I have either used myself, 
or sent to others. I hope this treatise, imperfect as it doubt- 
less is, will still have the effecu of aiding the extension of 
the most beneficial discovery which has ever been made, by 
tending to allay improper prejudice, and imprudent fears, 
both in Parents and in Physicians ; and also of awakening 
the philosophical researches of the curious, in order to as- 
certain with due precision, what is the real origin of this 
wonderful Prophylactic. 



* The favorite Sultana of the Emperor it is said, had her infant 
Vaccinated. 

§ " The first child that was inoculated for the Cow-pox in Russia 
was named by the Empress Dowager, VaccinofF, and a pension was 
settled on her." 



^pprntjir, 



CONTAINING 

First — Various Letters on the subject of the spurious cases 
of Vaccine which occurred in New-York, Norfolk, and 
elsewhere. 

Second — A set of Tables and Notes comprising the outlines 
of some of the first cases of the Vaccine which came 
under my care. 

Third — Sundry Remarks and Observations, SCc. which 
have occurred to my notice since the publication was 
put into the hands of the Printer, and which I must 
have introduced here, or have altogether omitted. 




Extract of a letter to Doctor Hosack, dated Philadelphia, the 
IQth cf January, 1802. 
" IT has been reported in this city, that you have had 
under your care, a child who took the Small-pox, after having 
passed through the Vaccine disease, and it has been urged by some 
as a cause for doubt of the efficacy of the latter in preventing the 
former. As this case militates so strongly against the present 
received opinions on this point in Europe, as well as against the 
experience I have had in several instances, I can scarcely doubt 
that the account has originated in some misrepresentation, and in 
consequence, most earnestly desire to have it from the fountain- 
head, as the only method of coming to the truth, &c. 

" I am, Dear Sir, 

** Your very obedient Servant, 

'< JOHN REDMAN COXE." 



128 

SH? this I received the following Jns<wer. 

f* New-York, January 15, 1802. 
t{ Dear Sir, 

" IN reply to your polite letter of the 10th instant, 
I beg leave to assure you, that the report of a child having had 
the Kine-pox under my care, and afterwards taking the Small- 
pox, is incorrect, though not perhaps altogether without founda- 
tion. 

tf As it may not be uninteresting, I will relate to you the whole 
circumstances relative to the Vaccine inoculation, as far as I have 
hitherto had any concern it. 

" Very early after the discovery of Doctor Jennet my friend 
Doctor George Pearson, of London, sent me some of the Vaccine 
matter ; but the thread imbued with it being only inclosed in a 
letter, I was not surprised to find it had lost its virulence : Imme- 
diately upon receiving it, I obtained permission from the inspec- 
tors of the state prison, to introduce it in that house, and inocu- 
lated two of the prisoners. 

tl Although I was careful to introduce the thread below che skin, 
and afterwards to retain it in its situation by adhesive plaister, it 
did not in either case excite more inflammation than the thread 
uninfected, would have occasioned. Upon receiving a second 
thread from Doctor Pearson, and the testimonies in favour of Vac- 
cine inoculation contained in his and Doctor Jenner's publicati- 
ons upon that subject, I did not hesitate to inoculate some of my 
private patients with it. I accordingly, with every possible pre- 
caution, inoculated six children with it ; the result was the same 
as had occurred in those I had inoculated in the prison ; very lit- 
tle inflammation was excited, not more than was produced by 
the wound and thread alone. Still confident of the advantages of 
Vaccine inoculation, and being informed that Dodtor Jackson, 
of Boston, had lately arrived from England, and was supplied 
with the genuine matter, which he was at that time successfully 
employing at Boston, I applied to Mr. Quincey to procure 
me s >me of it from Doctor Jackson ; he accordingly obtained it 
and carefully enclosed it in a phial, in such manner that it could 
undergo no change from the air : Without delay, I again inocula- 
ted six children with it ; among others, a child of Mr. Charles 
Wilkes, Cashier of the bank of New- York ; upon the third day, 
I examined the arms, and found them all very much inflamed, so 
much so, that I had no doubt of my success, with this third at- 
tempt ; the inflammation continued, and extended about an inch 
around the part inoculated, and in each a pustule was formed, 
which filled with a watery matter, and did not heal in less than 
ten or twelve days from the time of inoculation. 



I 



129 

"Upon the eighth and ninth days, Mr. Wilkes's child had- 
manifestly a degree of fever; in the other children there was no 
observable indisposition ; there was no eruption upon the skin in 
either of them ; but the inflammation of the arm was so great in 
all, that I had no doubt of the success of this inoculation ; but 
to ascertain it, I afterwards inoculated them with the Variolous 
matter : to my great surprise, the arms inflamed, they all sick- 
ened, and each had a considerable number of pustules. The con- 
clusion I drew from the above circumstances was, that the matter 
sent me by Doctor Pearson had totally lost its activity, from the 
open manner in which it had been conveyed, and the great length 
of time that, necessarily elapsed before I received it ; that the 
matter sent me by Doctor Jackson, was either not the genuine 
Vaccine matter, that it was not taken at a period of the disease 
in which it possesses the most active properties ; or, that it had 
undergone those changes which Doctor Jenner has stated it 
to be subject to. 

*' My want of success has, however, not altered my faith upon 
this subject ; the almost unanimous testimonies in its favour are 
not to be resisted ; in our own country, we have abundant proof 
ofits utility, &c. &c. 

" I am, Dear Sir, with great regard, 

« Your's, DAVID HOSACK. 

" Dr. John Redman Coxe." 

The following is an extract from my reply to the aho-ve, dated 
January l8/£, 1802. 

** Allow me to thank you for your satisfactory letter ; I had ac- 
counted for the cases which came under your inspection, in the 
manner you have done, and am happy they have not damped 
your ardour. Permit me to ask the form and progress of the pus- 
tule, the colour of the scab, and whether you vaccinated with 
the matter of the pustules ? How long after the disea?e was it 
before you inoculated t >r the Small-pox ? Have you had any in- 
formation from Doctor Jackson, iclative to the matter he supplied 
you with ? 

" I hope you will pardon the trouble I give you, and believe 
me to be, Sir, 

" Your's sincerely, J. R. COXE." 

I'o which I received the following satisfactory reply. 

f( New-York, June %th t 1802. 
" Dear Sir, 

fi YOU will think me remiss in not having 
replied to your favour of January the 18th ; but I purposely post- 
poned my reply to the questions it contains, until my observations 

Ltt'l 




i jo 

spon'the Kine-pox have made me more familiarly acquainted! 
with the characters which distinguish the Gm///7# from the Spuriout 
kind. 

M I am now perfectly satisfied that the pustules which were 
produced upon the arms of those children I inoculaied with the 
matter I had received from Doctor Jackson, were very different 
from those of the genuine Cow-pox I have since employ d, and 
am at present in the use of: In the former a brown scab appeared 
very early after inoculation, which does not take place in the 
genuine Cow-pox ; the pustule had not in any stage of it that pe- 
culiar pearl colour, which characterises the genuine species ; the 
matter discharged from it was Uss limpid, more approaching in 
its appearance and consistence to common pus ; the pustule 
was not of so long duration, nor did it termit ate in th^ black 
scab, as in the genuine disease. The failure of those ca^es inocu- 
lated with the spurious matter stated in my first account, I learn, 
with' great regret, has given rise to a report in this city, which 
has prejudiced many families against the introduction of the Cow- 
pox ; but this prejudice must in a short time yield to the numerous 
testimonies which we now possess, to shew that the genuine Cow- 
pox is a perfect security against the Small-pox. 
"I am, Sir, with great regard, 

«« Your's, DAVID HOSACK. 

"Dr. John Redman Coxe." 

The following letter I received from Doctor Balfour, of Nor- 
folk, in consequence of a request to obtain for me every possible 
information relative to the spurious disease excited there. 
j) , 

" Norfolk, March 25, 1802. 

"To Doctor John Redman Coxe, Philadelphia. 

"Sir, 

" WHEN I last had the pleasu-e of seeing you in Phila- 
delphia, you were so good as to furnish me with some of the fresh~ 
est Vaccine fluid in your possession, f then promised to give you 
an account of the success I should meet with in propagating it in 
this place, and the history I cpuld collect (fori did not then reside 
in Norfolk), of the spurious disease which existed here the last 
year, and at that time was called Cow-pox. That it was a spurious 
disease there is now no doubt ; the event too truly proving — for 
unfortunately those who had th ; s false infection, afterwards took 
the Small-pox, and some, it is said, fell victims to the decep- 
tion. 

"The impression made on the public mind, in consequence of 
this error, is a perfect horror at the name of Cow-pox : It has 
been further increased bv the true Vaccine matter (with which 
several have since been inoculated), having failed to produce any 



I 



13* 

disease at all ; its infecting powers from keeping being lost. The 
females of this city are particularly opposed to the Vaccine inocu- 
lauon ; so violent are they, that they generally declare they 
would rather their children should have the Small pox, and run 
their chance." 

*' 1 will now give you an account of the success of my practice : 
On the 7th of February, the day after I saw you, Doctor Currie 
of Philadelphia, kindly permitted me to take the fluid from the 
arm of a child under his care. It was on the ioth day, the areola 
just beginning, (I should have preferred it sooner). The same 
evening I left Philadelphia by water, and arrived here on the 
17th fuliowini — i immediately inoculated a gentleman's child of 
this place, (Mr. Martin Fisks), and his negro woman: On the 
fourth day it was evident the infection had taken. In both cases 
the disorder progressed and declined in its most regular form ; by 
the 2zd of March there remained nothing but a hard shining 
scab, when I inoculated them both with fresh Small -pox matter; 
their arms were inflamed a little on the second day, but by the 
sixth were perfectly dried up, without producing the smallest af- 
fection of the system. Not perfectly satisfied with this assurance, 
knowing the public prejudice, I again inoculated both the child 
and negro woman with fresh Variolous matter from different per- 
sons. At the s/ime time I inoculated with different Small-pox 
matter, a child of Mr. Lynch's, and a negro child of Mr. Beale's, 
both oi whom had just got over the Vaccine disease ; but in every 
case the re-ult was just the same, a small inflamed spot was visi- 
ble on the second day and beginning of the third, but by the 
sixth was dried universally. 

"Thus have we at length succeeded after so many unsuccessful 
trials, in introducing into this town the mild antidote to Small- 
pox. So many attempts had been made before, without success, 
that even medical men declared they did not believe the disease 
could be brought here. 

* c It will, no doubt, take some time to remove the obstinate pre- 
judice of the public ; but like ail great truths, it ultimately must 
prevail, and surmount every obstacle ignorance can oppose. 

" Eighteen have had the disease in its mildest form, and numbers 
are now under inoculation. Not the least medicine has been 
required in either of the cases — -not one has been kept for a mo- 
ment from their labour or business — in no instance has there been 
an eruption of any kind ; their arms have not been sufficiently 
sore to require any attention, not nigh as much so, as in Small- 
pox. The fluid has universally been taken on the seventh, eighth 
or ninth days, never later, and always before the appearance of 
the areola. 

" There is one circumstance I must remark ; I observed that the 
threads t have seen impregnated, have always been fine flaxen 



I3t 

thread, the matter, whether Vaccine or Variolous, forming a crast 
on the outside. A thread of this kind is generally extremely stiff, 
and on being handled is apt to crack and make the dry matter fly 
off; to avoid this, I have preferred a cotton thread of double cr 
treble the size commonly used, and but slightly twisted : I am 
much mistaken, if to this apparently trifling circumstance, I am 
not in a great measure indebted for the facility with which I have 
communicated the disease ; for with the cotton thread, I can as 
freely give the infection when the matter is a number of days old 
(by moistening it with a little warm water or steam) as with the 
fresh fluid from the arm. 

<$ I have inoculated myself and another person, both of us had 
Small-po* in our infancy, decisively, having had fever, and a 
large number of pustules ; b it the result ha: been quite different 
from thv experiments made in Europe by Doctor Pearson, for our 
sys:-ems were both considerably affected, (and in the same man- 
ner), indeed more so than any of those I have vaccinated, who 
have not had Small-pox. The appearance of cur arms was, how- 
ever, quite different from theirs ; we were inoculated with fluid 
taken warm from the arm on the eighth day ; on the fourth, there 
was considerable inflammation ; on the same day the efflorescence, 
or areola, took place, extending three-fourths of an inch from the 
point of inoculation ; no pus'ule wa,s formed, as in those who had 
not had Smatl pox ; but a very small sore, depressed, and not a 
tenth part as big as in the regular infection ; on the sixth day we 
both had considerable fever, puking, violent head-ache, and 
creeping chills over the whole body, particularly the back. Our 
appetite iorsook us at the same time, and the glands of the axilla 
swelled and were painful : On the eighth day those symptoms aba- 
ted, the inflammation of our arms gradually subsided, (sooner 
than in the regular disease) and on the thirteenth day, little re- 
mained but a scab (not much bigger than a large pin's head) ; 
and a peeling of the scarf-skin as far as the areola had extended : 
As 1 observed before, I have not had a single patient who had 
not had the Small-pox, who had the disease nearly as severe as 
we had. 

45 We have a third time inoculated for the Small-pox without ef- 
fect : One person of seventy years of age has gene through the in- 
fection, and afterwards perfectly resisted Small -pox— forty odd are 
r.ow under Vaccination. 

" I am, with great respect, 

«f Your obedient servant, 

" GEORGE BALFOUR." 
On the ioth of January, 1802, I wrote to Doctor Taylor, of 
Norfolk, requesting him to give me every information, relative 
to the same subject* I had previously written to Doctor Barraud, 
pf the same place. Those gentlemen did me the favour of reply- 
in?, as follows : 



133 

" Norfolk, April i$th, 1802. 

ie Dear Sir, 

ft WE feel ourselves obliged by your late com- 
munications on the subject of the Kine-pox, and for the trouble 
you have taken in possessing us with the Vaccine infection. Our 
acknowledgments would have been made more promptly, but that 
we wished to give you the fullest result of our lab urs ; and al- 
though we have again to regret that this benign antidote to Vario- 
lous contagion has another unlucky incident thrown in irs way 
by this late attempt to propagate it, yet we will relate to you the 
effects of our endeavours to introduce it in the last and present 
year. 

" In the first of the year 180 1, some threads were sent hither by 
Doctor Spense, of Dumfries, with assurances that they contained 
the genuine Vaccine infection ; coming in a direct way from Pro- 
fessor Waferhouse— We had for some t nr anxiously wished for 
the means of introducing the dLease, and we seized the opportu- 
nity of immediately essaying it. 

" Parts of these threads were distributed to several gentlemen 
of our faculty in the town, and were severally used — Appearances 
were flattering in a high degree; an early inflammation followed 
the insertion of every thread almost without an exception ; a pus- 
tule formed in the ordinary time, and the several characteristics 
of this inoffensive disease seemed to us complete. A sufficiency 
of infection was readily produced to proceed in our work — in se- 
veral cases the arm was trotiblesome'y sore, and in four instances 
under < ur immediate care there was fever that proved inconveni- 
ent for a day or two, attended with eruptions as abundant as gene- 
rally are found in the milder Small-pox. About eighty persons 
had been subjects of this inoculation, when' we procured some 
Variolous matter which for some weeks we h^.d not been able to ob- 
tain : That we might defeat all the scruples of those who ever 
oppose innovations, we determined to test it with this infection, 

** The experiment was wholly unfortunate. Every person took 
the Small- pox, and went through it under all the ordinary cir- 
cumstances. 

f< Our disappointment was extreme- — It was increased by our 
having circulated this infection among our distant medical bre- 
thren, with accounts of our own success ar?d the progress we were 
making-— -Several of these gentlemen used it extensively, wish 
disappointments similar to ours. Dr. G. of Williamsburg, had 
several patients as much distressed with the fever as is seen to be 
the case in inoculated Small-pox ; two arms were sore enough to 
require the surgeon's aid for seme weeks. 

" Doctor Dick, of Alexandria, another of our correspondents, 
relates, that a person inoculated with some of this maiter, after 
having gone through the disease, resisted the Small- pox with 
which he was several times inoculated, and that at the end of 



*34 

some few months, he took it in the natural way, And had it ««* 

verely. 

■' Here then we seem to have unluckily received an anomalous 
disease, that late experience »n Kine-pox shews us to follow av\ 
untimely regard in taking the fluid from the pustule 

"In he late winter we had some communications wi.h Mr. Jef- 
ferson, who was made .cquainted with our disappointment He 
was obliging enough to send us a phial conta ning some infection 
that he recommenced as fresh and genuine : At this very moment 
your own favours were received. With these authorities we were 
enabled to make fresh exertions to promote this work of humanity, 
this most estimable discovery of all the last century. To quiet 
all objections, we commenced with one of cur own infants, and 
very soon after seventeen others submitted to the experiment.—- 
.Again we exposed ourselves to new mortifications ; our threads 
all proved ineffectual to our purpose, although we inserted them 
again and again. It follows that the delicate fluid, in these last 
cases, had suffered in travelling the short distance to us ; or that 
some unlucky incident occasioned its destruction. Yet the phial 
received from the President, came to our hands most carefully 
sealed, in a few days after the fluid was collected ; and the inge- 
nious method of coating it with the gold-beater's skin would seem 
to have defied all hazards. I mention these circumstances, merely 
to evidence the peculiar nicety that must be regarded in keeping 
or transporting this infection. 

'« While we were determining these last trials, Doctor Balfour 
brought with him from Philadelphia, some infection that has 
proved good ; but for this, we should have intruded on you once 
more. 

" We have some patients now under inoculation with some of 
this last infection, and if we meet with any circumstance worthy 
your rvotice, we will make it knowu to you. 

*' It is desirable that the friends of Medical science should watch 
over this new subject in the healing art, that they may entrench 
it from the accidents, and secure it against the tactions to which 
it seems exposed from its novelty and its nature. Assuredly it 
sails forth the patrons of humanity, and the ingenious enquirer. 
" With respect we are, 

4t Your obedient Servants, 

" JAMES TAYLOR, 
" P. BARRAUD" 

These important and interesting communications will, I trust, 
be a guard against future danger, by shewing the great atten- 
tion which is necessary to become acquainted with the respec- 
tive characters of the two diseases, I now proceed to the tables. 



<5 



Subject. 
Nartie and Age. 



Vaccine 

whence obtain. 



John R. Coxe 
5 attempts 
6th 


J. Ricart 6 mo. 
S. George 5 mo. 
E. Lige 3 mo. 
c 







MV.King,Loo- 

(ion. 
Mr. Jefftrson 



unkno^ 

8th 



Busy Ginn 
6 yrs. 1st atpt. 

2d 

3d 

4th 

5* 



Mr. R 



ng 



Mr. Ring 

do. 
Mr. Jefferson 
Case 1 



Andrew Boziei 
28 yrs. 2d atpt. 



Richard Bozier 
3 years, 2d 
3d 



Moily Bozier 
1 yr. 1st atpt. 
2d 
3d 
4th 
5 th 
^th 
7 th 
8>h 
9th 



- Maxwell 



Sibelia Peale 

3 years. , 



Lyttleton Ginn 
29 years. 



Joseph Lee 
3oyrs. 2datpt. 



Geo. Patterson 

25 years. 



Asa Warren 
5 years. 



Mr. Jefferson 
do. 



Mr. Jefferson 

do. 
Mr. Ring, Lon- 
don, 



Mr. Jefferson 

do. 
Mr. Ring 
Case 1 
8 
tin known 
26 
*3 
3* _ 



Infec 
day tak 



nkno^ 



unkno\ 
do. 
8th 

8 th 

9 th 
8tiT" 
8th 



8 th 

do. 

unkno' 



8th 

do. 

unkno' 

9th 

8th 

unknot 

15 th 

10th 

8th 



Case 



Case 8 from the 
pock produ- 
ced by the 3d 
attempt. 



Case 



unknown 
Mr. Jefferson 



Case 8 



8th 



9 th 



8 th 



8th 



9 th 



II By incision js meant merely a long division 
a thread. 



9 


Subject. 
Name and Age. 


Vaccine 


Inffc't 
day taker 

8th 


135 
ON. jhowin- 
how old troduced 


j Issue,ofthe 
j attempt. 


j Constitutional indis 


General Disease. 
position. 1 Eruption, and where. 


i 


John TlTCoIe - 
5 attempts 
6th 


Mr.X.„g ; L..n- 
Mr. Jefferson.' 


unknown 1 3 punct 
5 days [3 thread 


fails 

2 successful 


Head-ach, fever, drowsy, com 
mencing on the fifth day, continu 
ing three or four days. 


None. 


3 

4 
5 


J. R.cart 6 mo. 
S. George 5 mo. 
E. Lige 3 mo. 


[•Mr. R'ng 


unknown 


„„ t „o.„ 


7 punct 


fail 


As all these cases failed in repeated attempts with the first infection 1 
received from London, I had inoculated them for the Small-pox before 
I obtained a fresh supply. 


6 


Betsy G.nn 
6 yrs. 1 st atpt. 

ad 

3d 

4th 

5th 


Mr. Ring 

Mr. Jefferson 

Case 1 
7 


unknown 

do. 
8th 
Sth 
9 th 


unknown 
do. 
5 days 


3 punct. 

do. 
3 threads 
3 punct. 
3 do. 


fails 

do. 

succeeds 

fails 

succeeds 


Scarcely perceptible. 


A scratch of a cat upon the wrist, 
in consequence I suppose of the 
Vaccine matter coming in contact, 
produced a perfect pock. 


7 


Andrew Bozier 
2 8yrs.2datpt. 


Mr. Jefferson 
do. 


8 th 
8th 


5 days 
8 
♦ 


3 threads 
2 do. 


fails 
succeeds 


About the twelfth much mdispo-j At least thirty small fiery looking 
sition, consequent to the too free usejp ; mples around the pustules, which 
of his arm whilst the axillary glands disappeared in about three days. . 
were inflamed. | 


8 


Richard Bozier 
3 years. 2d 
3d 


Mr. Jefferson 

do. 
Mr. Ring, Lon- 
don. 


8th 
do. 
unknown 


5 days 
8 
10 weeks 


3 threads 
3 threads 
2 punct. 


fails 

succeeds 

succeeds 


No indisposition till the scab 
were rubbed of on the eleventh, wher 
an ugly ill-conditioned ulcer, consi 
derably deranged the constitution. 


Five pustules, on the vaccinated 
parts alone ; three or four fiery look- 
pimples on the eleventh day within 
the limits of the areola, they were 
gone by the fourteenth. 


9 


Molly Bozier 
1 yr. 1st atpt. 
2d 
3d 
4th 
s th 

6 th 

7 th 
8ih 
9 th 


Mr. Jefferson 

do. 
Mr. Ring 

Case 1 
8 
unknown 
z6 
*3 
32 


Sth 
do. 

unknown 
9th 
Sth 
unknown 
15th 
10th 
Sth 


5 days 
8 

10 weeks 
1 day 

unknown 

39 days 
54- 
4 


3 threads 
3 do. 
3 punct. 
3 do. 

1 incisn.| 

2 punct. 
t do. 

1 do. 
1 do. 


fails 

do. 

do. 

do. 

do. 

do. 

do. 

do. 
succeeds 


None perceptible. 


None. 


o 


Maxwell 


Case 1 


Sth 


2 


3 punct. 


succeeds 


Slight fever and head-ach for three or four days. | None. 




Sibella Peale 
3 years. 


Case 8 from the 
pock produ- 
ced by the 3d 
attempt. 


9 th 




1 punct. 


succeeds 


Drooping ninth and tenth days, onl A considerable eruption of the 
the eleventh lively, on the thirteenthjChicken-pox on the back, face, and 
feverish and restless. extremities, amounting nearly to 
[eighty in number. 




Lyttleton Ginn 
29 years. 


Case 8 


8 th 


4 


2 threads 


succeeds 


Chilliness, succeeded by 
fever, head-ach, and pam 
of back ; nausea and vomit- 
ing, on the ninth, tenth, 
eleventh and twelfth days. 


On the 12th day several minute pimplesap- 
peared around the pock. On the 1 5th day of 
the Vaccine, 16 days from exposure to the 
Natural Small-pox, and ten from Variolous 
inoculation, he had an eruption of the Small- 
pox about forty in number. 


3 


Joseph Lee 
30 yrs. 2d atpt. 


unknown 
Mr. Jefferson 


8 th 


22 


2 punct. 
i thread 


succeeds 
do. 


ach &c. continuing a few days; then above th ; rty Variolous pustules, 
subsiding, when a new set of symp- nine days from inoculation and 
toms more violent attended, with eighteen from first exposure to the 
nausea and vomiting about the ele- Variolous contagion, 
venth dav. 


+ 


Geo. Patterson 
25 years. 


Case 8 


8 th 


10 


2 incision 


succeeds 


Ninth day consider.! 
nausea and vomiting on t 


he 10th. t 


ion ; being the 25th day from expo- 
ure to the contagion. 


5 
tr 


Asa Warren 
5 years. j 

| By incision is me 
read. 


Case 10 

ant merely a long 


9 th 
division of 


the cuticle 


, punct. 

, without 


succeeds 
the insertion of 


Head-ach, and drowsi- 
ness the 3d day, slight le- 
ver on the 9th &c. from 
having the scab rubbed 
off; also on the 27th aSth 
and 29th. 


rable number broke cut, large, and filling with 
a limpid fluid, which dried away on the 3d, 4th, 
and 5th days. This child was almost con- 
stantly exposed to the Variolous contagion du- 
ring the progress of the Vaccine. 



19 



Subject, i Vaccine InfectiOi. 

Name and Age. whence obtain, jdny taken] h 

Iff 



Jas. Patterson 
3 months. 



Katy Smith 
7 months, 2d 



Leah Rogers 

i year. 2d 

3d 



Benj. Rush, jr 

10 y-ears. 



Mrs. Morris 



H. C.Meade 
6 weeks. 



William Webb 



Miss Forman 



Jacob Clarkson 
20 years. 2d 



JennyBoon, 1st 
40 years. 






John Talbot 



Wm. Chipley 



>. Ffireh 



3d 



E. Jenner Coxe 
23 days. 



Case 10 



Case 



Case 16 



14,15, i6',mixd. 



Case 15, 16. 



Case 1 1 
(Englifhftock) 



Case 


J 5 




Mr. 


Jeffer 


son 


Case 


10 




Case 


6 
10 





C. 15 16 mix"d 



Case 23 
2 S 



Case 



Case 25 
29 



9th 
8 th 



7 th 

9th 

various 



various 



9th 



9th 



4th ; 
9th 



8th or Qtn 



10th 
6th 



6 th 



I 6th 

J 9th 



Case 23 



9th 



* This Instead of ths 4th. was in fact the 213 
was taken. 



n 


Subject. 


Vaccine 


Infecth 


SL 


Name and Age. 


whence obtain. 


day taken 


3° 


Titian Peale 


Case 1 1 


nth 




.2 vis. 2d atpt. 


do 


do. 




3d 


29 


8 th 




4th 


23 


nth 




5 ih 


3* 


8th 




6th 


37 


8 th 




7 th 


9 


7th 




8th 


22 


12th 




9th 


25 


6th 




10th 


41 


7th 




nth 


44 


8 th 




J2t!l 


75 


7 th 




14th 


76 


9th 




81 


7 th 




i<;th 


Variolous 






1 6 th 


Case 77 


10th 




r 


77 


10th 




37th 1 


84 


8 th 




I 


Variolous 




3* 


M. Jones 


Case 25 


7th 




10 months. 






3* 


Bridget Kerlin 


From a case or 


18th, see 




5 years. 


Dr. Hewson's 


case p. 27 


.3 3 


John Kerlin 


Case 26 


TKh" 




3 years. 2d 


do 


do. 


54 


Mary Kerlin 


Case 26 


"TTTh - ' 




10 months. 2d 


do 


do. 


J5 


Nisa Rogers 


Case 23 


10th. 




k years. 2d 


Mr. Jefferson 


8th 




3d 


Case 33 


8ch 




4th 


43 


7 th 




5th 


obt. elsewhere 


unknown i 


• 


6 th 


Case 44 


9 th 


3~6 


Pyirhus 


Case 22 


12th 




14 years. 2d 


37 


6th 

1 2th 3 


37 


Robert 


Case 22 




11 years. 






38 


John Heineken 


Case 32 


8 th 


__ 


2 years. 






39 


Sally Dunn 


Case 37 


6th 




7 months. 






40 


Betsy Dunn 


Case 37 


6th 




4. years. 2d 


39 


_9i!2 

6th 


41 


John Dunn 


Case 37 




2 years. 2d 


39 ■ 


10th 




3d 


4° 


9th 




4th 


42 


7 th 



* With matter faken on the seventh day, I imme 
punctures in a w?ek afterwards, with matter of case 
time gone with young : What influence this might ha 



n 


Subject. 
Name ;uid Age. 


Vaccine 
whence obtain. 


Infecti 

day take! 


<>»• .| how in- j Issue of the 
[now old trodiiced.l attempt. 


I36 

" Gejneral Disease. 


(■, 


Jus. Patterson 
3 months. 


Case 10 


9th 


* days 


1 punct. 










Iretruion the gth.fiom 

the peck being much rub- 
bed.- From the 13th to 
15th feverish at night. 


On the j 6th day, 3 or 4 very distinct Vari- 
olous pustules appeared on the face, which 
maturated rapidly ; both diseases were well by 
the 20th. In 7 weeks from Vaccination, 


7 


Katy Smith 
7 months, zd 


Case 1 
»3 


9th 
8th 


11 

3 


1 punct. 

1 punct. 


fails 
succeeds 


Slight indisposition on the ioth.| None. 


8 


Leah Rogers 

i year. 2d 

3d 


Case 16 
14,15, i6',mixd. 


7 th 
9th 


recent 

1 
various 


1 punct. 
1 do. 
1 do. 


fails 
do. 
succeeds 


Restless and fretful the 8th day, 
probably from her teeth which eame 
through about this time. 






None. 


y 


Benj. Rush, jr. 
10 years. 


Case 15, 16. 


various 


various 


1 punct. 


succeeds 


Very slight. j None. 





Mrs. Morris 


Case 1 1 
(Englifh ftock) 


uth- 


3 days 


1 pun. in 
each arm 


Succeeds jihe 
arms were in- 
flamed but 
not much evi- 
dence of pus- 
tules at the 
late period of 
the 8th day. 


On the 6th day pain of the ax- 
illae, restless and fonsiderably fe- 
verish on the 7th, chilly on the 8th 
and 9th, with fever dull and hea- 
vy. 


At about 12 days from Vaccina- 
tion four pustules were discovered 
in different places; I could not as- 
certain by the account I received if 
they possessed the true Vaccine cha- 
racter. I rather imagine they were 
adventitious pimples. 


1 


H.-C. Meade 

6 weeks. 


Case 15 


9th 


recent 


1 punct. 


succeeds 


Drowsy on the 6th with slight 
starting occasionally at night. 


A small pimple on one leg the 
5th day, g;one the next. 


; 


William Webb 


Mr. Jefkrson 


8 th 


35 days 


1 thread 


succeeds 


Eyes painful, feverish on the 10th 
continuing two or three days. 


None. 


3 


Miss Forman 


Case 10 


9th 


13 


1 punct. 


succeeds 


Drowsy on the 6th, slight indis- 
position about the nth day. 


None. 


+ 


Jacob Clarkson 

20 years. 2d 


Case 6 
10 


4th * 
9th 


17 
20 


1 punct. 
1 punct. 


both succeed 


Considerable fever 9th to 12th, 
itching considerable. 


None. 


5 


Jenny Boon, 1st 

40 years. 

2d 


C. 15 16 mix'd 


8thor9lh 

I 2th 


1 


2 punct. 
1 punct. 


Creeping 
scabs consi- 
dered as spu- 
rious. 

Succeeds. A- 
bout the 13th 
all 3 scabs 
rubbed off. 


Slight fever about the nth day, 
on the 15th violent fever, tension 
and inflammation of the arm, ending 
in ulceration with aggravated symp- 
toms. 


None. 


6 


John Talbot 

2d 


Case 23 
*5 


10th 
6 th 


6 
recent 


hread 
1 punct. 


fails 
succeeds 


Drowsy with slight head-ach on 
the 7th and a fullness of the eyes on 
the 12th. 


6 or 7 minute pimples near the 
pock about the 12th day, speedily 


7 


Wm. Chipiey 


Case 25 


6 th 


1 day . 


1 punct. 


A creeping 
scab consider 
edas spurious 


But slight indispostion, much 
itching. 






S. Ffirth 

2d 

3d 


Case 25 

2 5 
29 


6th 
6th 
9th 


7 

J 

14 


1 punct. 
1 do. 
1 do. 


failed 
do. 
do. 






9 


E.JennerCoxe 
23 days. 


Case 23 


9 th 


1 punct. 


succeeds 


No indisposition appare 


U 


None. 



* This insteid of the 4th. was i 
wai taken. 



fact the aii day from Vaccination. I have marked it as the 4th, as it was this period from its progressing, that the mfectio* 











W- 












r 


Subject. 


Vaccine 




ION. 


how in- 


Issue of the 


„ . . General Disease. 
_Constitut,onal indisposition, j Eruptions, and where. 


J- 


Name and Age. 


whence obtain. 


[day take 


how old 


troduced 


attempt. 


3° 


Tit^n Peale 
.2 vis. 2d atpt. 


Case 11 
do 


nth 


34 days 
32 


ipunct. 
do. 


Fails. 
do. 






3d 


29 


8 th 


5 


do. 


do. 






41 h 


23 


nth 


33 


do. 


do. 






5ih 


32 


Sth 


recent 


do. 


do. 






6 tli 


37 


8th 


recent 


do. 


do. 






7th 


9 


7 tfa 


4 days 


do. 


do. 






8th 


22 


1 2th 


54 S 


do. in 


I do. 






9th 


25 


6 th 


57 2 


each a'fn 








10th 


41 


7 th 




do. 


do. 


"" 




nth 


44 


Sth 


z 


do. 


do. 






izth 


75 


7 th 


1 


do. 


do. 






x^h 


7 6 


9th 


recent 


do. 


do. 






14th 


81 


7 fh 


recent 


3 do. 


do. 






15th 


Variolous 




5 t|a y s 


1 do. 


do. 






i6th 


Case 77 


10 th 
10th 


7 


2 do. 


do. 






17th ) 


84 


8th 


4 


2 do. mix 


do. 




_ 


I 


Variolous 




17 1 


ed. 






3' 


M. Jones 


Case 25 


7 th 


17 


1 punct. 


fails 


This case was not vaccinated a second time in consequence of some 




10 months. 












doubts in the mother's mind. 


32 


Bridget Kerlin 


From a case of 


i8th, see 


2 


1 punct. 


succeeds 


Slight indisposition, and ramb 


None. 




5 years. 


Dr. Hewson's 


case p. 27 








ling on the 7th day. 




3 3 


John Kerlin 


Case 26 


1 S th 


8 


1 punct. 


fails 


Fretful tire ninth night. 


None. 




3 years, 2d 


do 




13 


do. 


succeeds 




34 


Mary Kerlin 


Case 26 


1 S th 


8 


1 punct. 


fails 


Restless and feverish 


On the 9th, 3 or 4 small pimples appeared on 




10 months. 2d 


do 


do. 


13 


do. 


succeeds 


the 9th and 10th days. 


the arm above the Vaccine pock, which by the 
13th had all but one disappeared ; This shewed 


















the genuine Vaccine character. 


35 


Nisa Rogers 


Case 23 


IOth 


32 


1 punct. 


fails 


Much nausea and vomiting fiom the spurious disease, pro- 






35 years. 2d 


Mr. Jefferson 


8th 


82 


thread 


spurious 


duced by the 2d attempt, attended with high fever, head-ach, 






3d 


Case 33 


8,h 


1 


1 punct. 


do. 


pain of back, lassitude, great local itching from 4th to 6th 






4th 


43 


7 th 


1 


2 do. 


fails 


day, with shooting pains and great axillarv inflammation. The 


None. 




5th 


obt. elsewhere 


unknown 


unknown 


1 do. 


spurious 


spurious disease by the 3d attempt was attended with great itch- 




6 th 


Case 44 


9 th 


recent. 


1 do. 


succeeds 


ing. Head-ach, fever, pain of the axilla, &c. f;om sth to 8th 
day. In the spurious disease by the 5th attempt the symptoms 
were less violent. The 6th and genuine disease was very slight, 




_ 














although the part was much irritated. 




30 


Pv.ruus 


Case 22 


I 2 th 


36 days 


1 punct. 


fails 


But very slightly indisposed. 1 None. 


_. 


14 years. 2d 


37 


6th 


recent 


do. 


spurious 


1 


3 7 


Robert 


Case 22 


12th 


36 days 


punct. 


succeeds 


Fever 9 ,h day wuh nausea and vomiting,! Nq ^ 
considerably indisposed to the 12th, | 


_ 


11 years. 












3^ 


John Heineken 


Case 32 


8 th 


4 


punct. 


succeeds 


Slight lever 101I1 day, wrthnau- 1 None< . 




2 years. 












sea and vomiting;. 1 


39 


Sally Dunn 


Case 37 


6th 


1 


punct. 


succeeds 


Fretful the ninth night, slight! None> 





7 months. 












r ever the tenth. | 


4° 


Betsy Dunn 


Case 37 


6th 




punct. 


rails 


Feverish 10th and 1 ith ; conside 1 One Imie pock formed on the verge 




4 years. 2d 


39 


9 th 


recent 


punct. 


succeeds 


•able fever with vomiting the 13th. |of the large one and ran into it. __ 


41 


Tohn Dunn 


Ca>e 37 


6th 


4 days 


punct. 


fails 


Considerable fever on the 10th 






2 years. 2d 


39 


10th 


recent 


punct. 


do. 


lay : Violent symptoms at a later 






3^1 


40 


9th 


lecent 


punct. 


do. 


period from repeated irritations of 






*th 


42 


7 th 


15 days! 


punct. | 


succeeds* 


he scab. 









* With matter taken on the seventh day, I immediately Vaccinated a cow 
punctures in a wsek afterwards, with matter of case 47 and case 49. The c 
time gone with young : What influence this might have, I know not. 



1 the teats in two places ; they however both failed, 
i was nearly dry when I first attempted it, and it was 1 



s did also a second trial by three 
■on discovered that she was some 



138 



Subject. 
Name and Age. 


Vaccine 

whence obtain. 


Infecti 

dav taken 


on. 
how old 


how in- 
troduced. 


Issue of the 
attempt. 


Constitutional indis 


Genera 

position. 


l Disease. 

Eruptions, and where. 


Kitty Keilin 
7 years. 


Case 34 


12th 


recent 


1 punct. 


succeeds 


Restless the 8th, 
scab complete the 12th, 
off the 18th. 


One pock on the inside of the right thigh, a P 4 

parently \ accme. It had an areola, | of an inch 
but was considerably rubbed before I saw if 


Marg. Barnhill 

2 years. 


Case 39 


7th 


recent 


1 punct. 


succeeds 


Drowsy the 5th and 6th days, slight indispo- | ■ — *■ 

sition the 10th, probably from a violent cold. | None. 


Mne. Davidson 
2 years. 2d at. 
3d 
4th 
5th 


Case 39 
43 
42 
4* 

47 


9th 
9th 
7 th 

7 th 
7 th 


recent 
4 
l S 

recent 
3 


1 punct. 
do. 
do. 
do. » 
do. 


fails 

do. 

do. 

do. 
succeeds 


No indisposition. 


'None. 


James Wilson 
17 yrs. istat. 

2d 

3d 


Case 43 
43 

39 

25 
43 


7 th 
9th 

9 th 

6th 
10th 


5 
7 

58 
8 


1 punct. 

do. 
1 do. in 
each arm, 
and also 
put on a 
sore from 
whence I 
rubbed a 
scab. 
ip.inea. 
thread in 
each arm. 


fails 
fails 

►fails 

one succeeds 
fails 


Went to the country as soon as 
infected. 




Wilkinson 


Case 42 


7 th 


15 


1 punct. 




Never called again, I know not if it took effect. 


Tom 
24 yrs. do. 
2d 
do. 
3d 
do. 


obid. elsewhere 
Case 33 
26 

Mr. Jefferson 
elsewhere 


unknown 

9th 
15th 

8th 

8th 

7 th 


unknown 
27 

49 

90 

119 

8 


1 punct. 
1 thread 

1 incision 

2 do. 
thread 
incision 


fails 

succeeds 

fails 

do. 

succeeds 

fails 


On the 8th day from the 2d attempt, during 
which I made the other trials, a very fine pock 
was advancing, from which I obtained some 
limpid fluid, a pain of the back and head, and 
of the pock, shooting up to the axilla attended 
with consderable fever. 


The small-pox broke 
out on the evening of the 
nth day ; which makes 
the 1 6th from first expo- 
sure. It was very thick 
upon him. 


Noah Molden 
24 yrs. 2d at. 
3d 
4 th 
5 th 
6th 
7 th 


elsewhere 
Mr. Jefferson 
Case 47 
elsewhere 
Case 44 

5 1 

5 * 


8 th 

8th 

8th 
8th 
9th 


unknown 
120 
3 
46 

recent 
5 


2 punct. 
thread 
1 punct. 
1 do. 
1 do. 

1 do. 

2 do. 


fails 
do. 
do. 
do. 
do. 
do. 
do. 


Did not take effect. See the Note. 


Matilda Evans 
5 months. 


Case 41 


7 th 


recent 


1 punct. 


succeeds 


Indisposition] On the 20th day several little pimples appeared on the 
scarce evident. |face and neck which soon dried away. 


Theodos. Pettit 
a mon. 2d 


Case 43 
44 


4th & 5th 
7th 


24 
recent 


1 punct. 
do. 


fails 

succeeds 
scab not off 
till 6 weeks 


Slight indisposition on the 13th. 


An erupuon ot smaii rea pim- 
ples on the hands and neck, on the 
1 5th, wjiich soon subsided. 


Thomas Burns 
4. mon. 2d 


Case 43 

44 


4th & 5th 

7 th 


24 
recent 


1 punct. 
1 do. 


fails 
succeeds 


Drowsy the 8th, slight indispo- 
sition the 1 2th, scab rubbed consi- 
derably. 


On the 2 
red pimples 


, continued a few days. 



(£3= From these tables it would appear, that of fifty-one cases, we must, to form an accurate statement, dedu. 
I received from England) repeatedly, without any effect ; hence I conclude its activity was totally destroyed 
Small-pox, and hence wens not altogether fair subjects. Cases 31, 46 (iaone of whom it was not repeated 



;es Z, 3, 4 , and 5, which were vaccinated (with infection 

.7, 28, 36, arid perhaps 48, which had previously had the 

second time, and the other I know not the issue of), making n» 



ft 

ft 


Subject. 
Name and Age. 


Vaccine 
whence obtain. 


Infecti 

dav taken 


4^ 


Kitty Keilin 
7 years. 


Case 34 


1 2th 


43 


Marg. Barn hill 
2 years. 


Case 39 


7 th 


44 


Mne. Davidson 
2 years. 2d at. 
3d 
4th 
5th 


Case 39 

43 
42 

4i 
47 


9th 
9th 

7 th 
7th 
7th 


45 


James Wilson. 
17 yrs. istal. 

2d 

3d 


Case 43 
43 

39 

2 5 
43 


7th 
9th 

9 th 

6th 
10th 

■ 


4 6 


— Wilkinson 


Case 42 


7 th 


47 


Tom 
24 yrs. do. 

2d 

do. 
3d 
do. 


obtd. elsewhere 
Case 33 
26 

13 
Mr. Jefferson 

elsewhere 


unknowr 

9th 
15th 

8th 

8th 

7th 


4S 


Noah Molden 
24 yrs. 2d at. 
3d 
4th 
5th 
6th 
7 th 


elsewhere 
Mr. Jefferson 
Case 47 
elsewhere 
Case 44 

5 1 

51 


unKnowr 
8 th 
8th 

8th 
8th 
9th 


49 


Matilda Evans 
5 months. 


Case 41 


7 th 


5° 


Theodos. Pettit 
2 mon. 2d 


Case 43 
44 


4th & 5tl 
7 th 


5i 


Thomas Burns 
4 mon. 2d 


Case 43 

44 


4th & 5 tt 
7 th 

• 



{£5= From these tables it would appear, that of fift 
I received from England) repeatedly, without any e] 
Small-pox, and hence were not altogether fair subje< 



NOTES referring to the preceding Cases* 

Case i. In this case (my own), head ach, fever, and drowfi- 
ness, indicated a constitutional affection on the 5th day, towards 
the close of wh<ch an areola commenced its progress. Two out 
of three attempts succeeded, the areolae of which uniting, formed 
one large one of an oval dupe, and full six inches in its longest 
diameter. — On the sixth day the axillary glands were swelled 
and attended with considerable pain, especially on pressure. — On 
•the seventh day of the disease I was called unexpectedly from town 
at 10 P. M. to see a person at twenty five miles distant. The 
night was dark and rainy, and at four in the morning the carriage 
was completely overset, by which I was compelled to stand in the 
mud and rain for half an hour before it was righ ed. Added to 
this, I experienced much anxiety and fatigue during the day, in 
my endeavours to reduce a strangulated hernia. I returned to 
town at four in the afternoon, which I did not reach till 
near midnight. During all this period I did not get any sleep, 
or but for a few minutes. I fully anticipated from all these cir- 
cumstances, considerable augmentation to the symptoms of the 
Vaccine, but was agreeably disappointed in finding no increase of 
symptoms, tt gave me great confidence in the disease, as it sa- 
tisfied me of its mildness and perfect safety. 

Since that period I have endeavoured to excite the disease in 
myself a second time, during a space of upwards of five months. 



all, ten cases: Of the remaining forty-one, it will appear that 
the first attempt it succeeded in 23, or nearly three-fifths 



second 




do. 


in 


10 


do. 




one-fourth 


third 




do. 


in 


z 


do. 




one -twentieth 


fourth 




do. 


in 


I 


do. 




one-fortieth 


fifth 




do. 


in 


2 


do. 




one-twentieth 


sixth 




do. 


in 


I 


do. 




one-fortieth 


ninth 




do. 


in 


I 


do. 




one-fortieth 


feven tee nth 


do. 


in 


I 


fails 




one-fortieth 


twenty - 


three, 


who took it by the first attempt, the Virus was ofc 


on the 


4th 


day in 


1 




9 th 


day in 7 




6th 


do. 


1 




nth 


do 


1 




7th 


do. 


2 




1 2th 


do. 


2 




8th 


do. 


6 




mixed, 


&c. 


3 



It abo appears I have succeeded with matter taken on the eighteenth day he, 
fore the areola was formed; with matter on the fifteenth day, taken at the re-* 
cess of the areola; and on the twelfth taken at its height. 

Of these cafes I have inoculated ab ut twenty, ineffectually, once, twice > 
thrice, and oftener, besides exposing several of them to the Small pox. 

For the particulars of each cafe; the reader is referred to the Note?, the 
timbers annexed to which, refer to the fime in the lift of €«•««. 



140 

In twenty two successive attempts I failed, although in most in- 
stances I employed recent matter. In some few instances an in- 
tolerable itcning, (commencing sometimes in three or four hours 
from inserting the infection), preceded and accompanied a little 
pimple which died away in two, three, and four days. 

In a twenty third and twenty fourth attempt, with matter taken 
from a most perfect pock on the eighth day,* I at length succeed- 
ed in producing a spurious pock. About twelve hours after Vac- 
cination the punctures were attended with an intolerable itching, 
and an fnflamed circle was very conspicuous. By the third day 
a considerable pock had risen in both places, which by the fourth 
had rapidly increased, more especially in one (the other gradual- 
ly declined), which now had a light but well defined areola 
around it of about three fourths ot an inch diameter, with a hard 
base ; the flat surface of the true disease was absent, yet something 
like depression of the centre was obvious. As it augmented, it 
assumed more of the Variolous character, the matter though lim- 
pid at first, putting on a purulent appearance in a short time. 
On the close of the seventh day a scab was forming, the itching, 
areola, and hard circumscribed base were nearly gone ; and the 
scab came off about the twelfth day, without assuming so dark an 
aspect as that which forms in the genuine disease. A slight eschar 
still remains. No indisposition was evident. 

Since this period I have renewed the attempt four or five times 
ineffectually. 

It may not be amiss to remark that all my first attempts by 
above a dozen punctures with infection sent me from England, 
failed ; as well as in cases 2.3.4 5.6. 

From a perusal of the case above related, I think it mus r , (in- 
dependently of the constitutional affection) be credited by most 
persons, that I really underwent the genuine disease ; were this not 
the case, I cannot suppose 1 fhould have failed so uniformly in 
eveiy succeeding attempt, as certainly, to a mere local affection, 
my system could not have been le.^s susceptible than before. 

Case 2. Four days after my last attempt in this case, the pa- 
tient broke out with the chicken pox. I have net fiace repeat- 
ed it. 

Cases 3. 4. 5. After the ineffectual attempts I made here with 
the matter sent me from England, as I had no immediate prospect 
of procuring more,! inoculated the patients. 

Cask 6. The third attempt succeeded, as may be feen by the 
tables, but it did not advance till the eighteenth day fix days 

* With matte'* taken the preceding day from the same pock, I excited 
a genuine case of Vaccine, which was as perfect in its appearance 3nd pro- 
gress as any I have seen. 



after I had succeeded in exciting the disease by other infec- 
tion. 

In this case the scabs were repeatedly rubbed off, but the sores 
healed kindly without any application. On the eighth day I ino- 
culated her with recent Variolous matter, taken from her mother 
who was then labouring under a very full burden of the Natural 
Small pox, to which she had been exposed constantly for seven days. 
The three punctures I made, inflamed, and produced three fmall 
local pock, unaccompanied with fever or any eruption : they dried 
away by about the twelfth day. 

Case 7. Considerable inflammation and increase of fever fol- 
lowed the imprudent use of his arm, which swelled greatly, but 
yielded to a smart purgative and saturnine applications. On the 
fourteenth day I sent him to see the woman abovementioned (mo- 
ther to the preceding case) and inoculated him on the seventeenth 
and twenty-second days, by two punctures each time, with recent 
Variolous infection. No effect but a slight inflammation for 
three or four days was produced. It was the first case I inocula- 
ted after passing through the Vaccine, and interested me very 
much. 

Case 8, This is the first sore arm I witnessed. The child was 
remarkably gross in his habit, and subject to a purulent discharge 
from the ears. The weather at the time was very variable with 
easterly winds. Being anxious to see the progress of the disease, 
I omitted both medicine and diet, which probably would have 
checked the violence of the disease. To this I must add, that I 
had produced three pock on the arm about one fourth of an inch 
apart, forming a triangle, with infection received from the Pre- 
sident : I vaccinated the child three days after, in two other pla- 
ces, about an inch on each side of the above peck, (with matter 
just received from England), in consequence of my belief that 
the other had failed. Both attempts however succeeded, and 
five pock were the result, The three first were repeatedly rub- 
bed off and at length formed one sore of considerable magnitude, 
and accompanied with great tension and inflammation of the arm 
and of the axillary glands. Citrine ointment checked the ulcera- 
tion, and some active physic reduced the febrile symptoms ; On 
the twentieth day I inoculated him with recent Variolous in- 
fection ; The punctures inflamed two or three days when an at- 
tack of measles supervened, followed by dysenteric symptoms, 
The healing of the ulcer was checked considerably ; and was not 
completely healed for two months. About ten weeks from the 
first attempt to vaccinate him I again inoculated him ineffectu- 
ally. 

Case 9, This case I vaccinated as the tables shew, eight 
times ineffectually , by seventeen different punctures during ft 

L is 3 



142 

space oi two months and an half, The ninth attempt succeed- 
ed ; an areola appeared on the eighth day, I inoculated her in 
two places ineffectually on the twenty first day. The matter 
which produced the disease in this case was taken from a patient 
in whom the disease was excited by infection of the eighteenth 
day. The infection of this case I forwarded to London, to try 
whether re-transplanting altered its efHcacy, 

Case io. This case was a student of medicine from Ken- 
tucky. He was inoculated on the eighteenth day with recent 
matter, which produced slight inflammation for a few days: 
about seven weeks after it was ineffectually repeated. He several 
times also exposed himself to the infection from others. 

N. B. From his arm a fellow student in the same room who 
had had the Small pox, vaccinated himself, and produced two 
most perfect pock, accompanied with a constitutional affection 
unequivocally marked. 

Case ii. This case had no areola. On the thirteenth day 
the scab, which had been progressing, was suddenly suspended ; 
early on the fourteenth 1 an eruption of the Chicken pox, conti- 
nuing to appear for three days, and drying on the fourth. Dur- 
ing this period the Vaccine was completely stationary. On the 
fifth day the eruption was nearly dry, when immediately the 
Vaccine resumed its progress, and terminated favourably the 
twenty eighth day. Soon after this she had the Measles. Six 
months afterwards I inoculated her ineffectually by ihree punc- 
tures ; a local irritation for a few days was the only effect pro- 
duced. 

Case 12. This is the father of cafe 6, and was exposed to the 
Variolous contagion from his wife one whole day previous to Vac- 
cination, as well as during its whole progress. On the sixth day 
I inoculated him with matter from his wife, as I feared the Vac- 
cine might not be sufficiently advanced to secure the system. The 
Vaccine progressed, and in proper time the Small pox made its 
appearance, about forty in number, producing around the cir- 
cular Vaccine a zone of confluent pustules, which gave it an an- 
gulated appearance in a short time. 

Case 13. This man had been exposed to the contagion of the 
Small pox two days before Vaccination. On the eighth day of the 
Vaccine I inoculated him. He broke out with the Small pox on 
the ninth day from inoculation, violent fever preceeding. About 
thirty pustules, which maturated quickly. The Vaccine by ir- 
ritation produced, a sore, which healed kindly in a few days. In 
these as well as most of the blacks, the local inflammation was not 
to be distinguished except by a hard and tumid base. 

Cases 14 & 16. The particulars of these casts are detailed 
at p. 76, et se%. 



143 

Case 15. The disease was very mild. A month afterwards 
I was told he had the Small-pox. It proved however only a case 
of Chicken pox ; his father who had had the Small pox long before, 
took the disease from him and broke out in two weeks with a pre- 
cisely similar eruption, after a slight indisposition of two days ; 
The eruption dried away in four or five days. From this case 
the subject of C. 16, also took the disease. See p, 78 to yg, 

Case 17, In this case the pock was rubbed off six or seven 
times successively ; it did not however appear to have destroyed 
the Vaccine disposition ; I am not positive, as I have never ino- 
culated her. 

Case 18, The pock on this child's arm was rubbed off at least 
six t mes without any bad consequence. A month after Vaccina- 
tion, I inoculated her, under a firm persuasion the Small pox 
would fellow, as I supposed the Vaccine disposition was certainly 
destroyed. A half filled pustule alone was produced with mode- 
rate local inflammation ; no eruption nor any fever but what I 
ascribed to some teeth (molares), which came through at this pe- 
riod with considerable difficulty. 

Case 19, This case had been twice inoculated when an in- 
fant, but it was doubtful if he had taken the disease. Much 
itching attended. 

Case 20. I have noticed this case, more in consequence of its 
having been mentioned by some as a proof of the violence of 
the Vaccine. This lady on the 3d day of Vaccination travel- 
led down to Washington, which it is highly probable at that 
inclement season (December) might of itself induce a febrile in- 
disposition, independently altogether of the Vaccine, which had 
scarcely on the 9th day enlarged itself to a pock. General Mor- 
ris in a letter to me of January 1 ith, after mentioning the pus- 
tules, adds, " though she has been indisposed since, which I at- 
tribute entirely to a cold." Mrs. M. afterwards suffered from an 
attack of Measles ; yet all her subsequent indisposition, was by 
many friends ascribed to the Vaccine. — This lady it will be seen 
by the tables, was vaccinated with matter which derived its source 
from the English stock I had received. The day after I had in- 
troduced the virus, I found the child from whom I obtained 
it had broken out with an eruption, which I satisfied myself was 
the Chicken-pox, but as it was the first eruptive case which came 
under my notice, it gave me some uneasiness. — These circum- 
stances, which I stated to several, I afterwards heard mentioned 
in a way, that I could scarcely recognize the original account. 

Case 21. In this case no areola existed ; she has however re- 
sisted the Variolous inoculation. 

Case 22. Areola about three inches diameter. On the 12th 
day when it was retiring, I obtained a considerable quantity of 



144 

matter. On the 19th day he visited a patient in the natural 
Small-pox and inoculated himself with the matter; since that 
time I have repeated it ineffectually ; and he has frequently visit- 
ed Variolous patients. A species of herpes existed on his arms, 
&c. which I hoped would have been removed; it was however 
not effected. 

Case 24, This man, I have understood, has, since he has 
crossed this " adamantine bridge," nursed several persons in the 
Small-pox, 

Case 25. The violence of this case I have noticed at p. 50, 
as also the abundant supply of infection it yielded at p. 31. 

Case 26. From this case I obtained matter nine days succes- 
sively, from the 7th to the 15th. The areola had nearly gone 
when I took the last portion, on the 15th day, with which I ex- 
cited the genuine disease in c. 33, 34, Before it began to scab 
(on the 1 6th day) it was I think full half an inch diameter. The 
scab did not fall off for five weeks. No sore arm was produced 
although the pock was punctured perhaps 50 times. 

Cases 27, 28. The subjects of both these cases were study- 
ing medicine : both had had the Small-pox when young. The 
first had a small tumour of a spurious nature, produced, attended 
with considerable itching and axillary inflammation. In the last, 
a slight inflammation appeared for a few days. I believe he has 
since ineffectually repeated the attempt several times. 

Case 29. The scab came off the 21st day ; when I inoculated 
him with recent matter by one puncture. I repeated it on the 
3 1 st day by two punctures, and in seven weeks from this time by 
three junctures without any other effect than slight local inflam- 
mation for three or four days. The matter was fluid from persons 
labouring under the Natural Small -pox. In four weeks from this 
last attempt, I sent him to see c, 47 on the 8th day of an ample 
eruption, of Small-pox. This man held the child one quarter of 
an hour in his arms ; but as may be expected without effect. 

Case 30. This child had just recovered from the Chicken- 
pox, taken from his sister c. 1 1. On the third day after the third 
attempt, he burnt his arm near the Vaccinated part. Is it pro- 
bable any effect was produced by the different irritation of the 
. burn, or by the constant application of lead-water ? At this pe- 
riod he became restless, eyes watery, &c. which continued the 
4th, 5th and 6th days, when the Meastes made their appearance ; 
they soon disappeared : The speck at the Vaccinated part conti- 
nued to afford hopes it would succeed. It soon however came to 
nothing. Between the nth and 12th attempt, a period of nine 
weeks elapsed, when I vaccinated his infant sister of four weeks, 
She took the inaction without difficulty by the first attempt, r.nd 



1 45 

had it in the highest degree favourably. With recent infection 
from her arm I again repeated it on him without effect, and five 
days afterwards I tried ineffectually to produce it by first rubbing 
the arm well, and then scraping off the cuticle with the shoulder 
of my lancet, making also several slight punctures, over which 
I deposited a large portion of infection. Variolous infection after 
a few days of local irritation dried away, as did likewise a mix- 
ture of Variolous and Vaccine infection What can be the 

reason of so constant an opposition to the Vaccine infection ? 
The system doubtless would be equally uniform in opposing the 
Small-pox. 

Case 31. Some doubts arising in the mother's mind, I did 
not repeat the attempt. 

Case 32. The scab came off the twenty-ninth day: On the 
thirtieth, I inoculated her with recent matter by two punctures. 
They inflamed a day or two and disappeared. 

Case 33. The pock in this case augmented in size, after 
the subsidence of the areola, to nearly an half inch diameter. The 
scab did not appear till the fifteenth day ; on the twenty-sixth I 
inoculated her with recent matter, which inflamed a day or two 
and disappeared. This and the next case were produced with in- 
fection of the fifteenth day. 

Case 34. In this case the scab was repeatedly rubbed off, 
but eventually healed kindly. The pimple remaining had every 
evidence of the Vaccine pock, the circular form, depressed centre 
and flattened surface, with a beautiful areola of half an inch ex- 
tent. With the matter I vaccinated her sister, c. 42. 

Case 35. This is a curious case ; of six attempts two proved 
abortive and three produced a spurious disease, with a creeping 
scab or incrustation, containing a purulent fluid. The constitu- 
tional symptoms ran very high in these spurious products, and 
local irritation and pain was excessive, whereas the genuine 
e was very mild. 

ase 36. This boy is supposed to have had the Small-pox. 
The pock never assumed the character of the Vaccine. It was 
accompanied with great itching and ran its course very quick : 
On the nineteenth day I inoculated him with no effect. 

Case 37- The symptoms in this case, seem to have run 
higher than usual. They arose however, I believe, from irrita- 
tion produced by too free a use of the arm : The pock was very 
large. On the twenty-fourth day he was ineffectually inoculated 
in three places. 

Case 38. This child was teething at the time of Vaccination, 
he also had a cough, and a complaint of his bowels arising probably 




146 

from the teeth ; and probably giving ri^e to the slight indisposi- 
tion on the ninth day. On the eleventh the areola commenced, 
continuing to the fourteenth or fifteenth. The pock increased 
after the subsidence of the areola till the seventeenth day, when it 
was, I think, nearly an half inch in diameter. The scab now began 
to form, and soon perfected itself. Although this pock had a most 
flattering appearance, I repeatedly punctured it without obtaining 
any matter, once alone I procured an inconceivably small quan- 
tity. After the areola had subsided, I did not attempt to obrain 
it, though I might probably have then got a considerable por- 
tion. 

Case 39. The areola in this case was the most perfectly cir- 
cular I have seen ; it came on the tenth day. The matter I ob- 
tained on the seventh day, I forwarded to England. About six 
weeks after I inoculated it ineffectually with recent matter; a 
slight inflammation for a few days only occurring. 

Case 40. This child had the scab rubbed off repeatedly, 
and received several knocks upon it, which produced great irri- 
tation and the consequent symptoms. By the end of six weeks 
it was nearly well. 

Case 41. This child was a fat gross habit, much troubled 
with worms and very fretful at the time of Vaccination. I gave 
no orders as to diet or physic, which doubtless tended to increase 
the symptoms. The pock was repeatedly rubbed off, and much 
irritation produced. The weather also was raw and wind at east ; 
the child was always in the streets, till at length the symptoms in- 
creased greatly, with extreme pain and inflammation of the axil- 
lary glands. It was difficult to induce physic to be taken, but 
* it was astonishing how rapid a change for the better took place 
after the operation of an active purgative. Poultices were requi- 
red to alby the inflammation, and the citrine ointment followed 
with advantage. It took up eight weeks. 

Case 42. I have said in the tables that this case was vacci- 
nated with infection of the twelfth day. It was in fact only of 
the fourth day, as it was taken from a secondary pock. The are- 
ola here commenced the seventh day and was nearly gone by the 
ninth. On the fifteenth day I inoculated her in three places with 
matter taken the preceding day from a person labouring under the 
natural disease. A slight inflammation for a few days was all 
the effect produced. 

Case 43. In this case I obtained matter on the ninety-third 
hour from Vaccination, or less than four days; I might probably 
have obtained it sooner. I procured it six successive days, by 
repeated punctures, yet without producing a sore arm, or in the 
least injuring the pock. She had a bad cold previously to, and 
during Vaccination. 



147 

Case 44. A short time after the first attempt, she was at- 
tacked with cynanche trachealis, which she recovered from in two 
or three days ; after passing through the Vaccine she was inocuu 
lated with recent matter, which appeared to inflame for a few 
days, and then Disappeared. She has also been exposed to the 
natural contagion ineffectually. 

Case 45. This young man was sent to Philadelphia for Vac- 
cination, in order to insure obtaining the infection, by Doctor 
Chapman of Bucks county, to whom 1 had ineffectually forward- 
ed matter. The disease after repeated attempts, was excited by 
infection fifty-eight days old. From him I understand the disease 
has been extensively communicated. 

Case 46. I understood this gentleman, he had had the spu- 
rious disease at Norfolk, or some place to which it had been sent 
from thence. I know not if my attempt succeeded, as he did not 
favour me with a second visit. 

Case 47. The original matter which I received from Mr. 
Jefferson appeared to take effect here, but as the Vaccination 
was performed only five days previously to the eruption of the 
Small-pox, the pock which was apparently rising with great 
regularity, soon assumed the angulated irregular form of that dis- 
ease from the confluence of the pustules. I have no doubt but for 
this circumstance, a true Vaccine pock would have advanced to 
maturity, from matter then nearly four months old. This man 
had been exposed to the Variolous contagion from a fellow-ser- 
vant, five days before the first Vaccination, ft will be seen that 
one of the first attempts likewise succeeded with infection twenty- 
seven days old, but which advanced so slowly that I had renewed 
the attempt, under the idea of its having failed. I obtained in- 
fection from this pock before the Variolous eruption. 

Case 48. At the time of my last trial, he told me that in 
autumn last he had an eruption, which was supposed to be the 
Chicken-pox, accompanied with fever, head-ach and pain of 
the back ; it was not violent, though a considerable crop attend- 
ed — a fe<v pits were left. Whether this might have been a light 
attack of Small-pox 1 know not : I however omitted any further 
attempt, intending to try again at a fature period. 

Case 49. On the fifth day a circular inflammation was ex- 
tending around the pock, and by night had increased to nearly 
an inch in diameter ; by the morning of the sixth it had entirely 
gone. On the ninth day the true areola commenced its course r 
terminating on the twelfth day. She has withstood the Variolous 
infection by inoculation. 

Case 50. On the nineteenth day I inoculated this child with 
recent injection ineffectually. On the fifteenth day an eruption 



M 

of small pimples appeared on the head, extending to the face 
and neck, which in three or four days subsided. 

Case 51. On the twenty-first day an eruption resembling 
that in the preceding case. In about ten weeks an eruption of 
small pimples attended with great itching ; it much resembled 
urticaria, coming out successively on the face, arms and body. 
It soon disappeared, and in a week or ten days was succeeded by 
a larger eruption, more resembling Chicken-pox, which also took 
place in the nurse. 



Remarks, Observations* &c. 

1THE following highly interesting case, whilst it proves the pos- 
sibility of passing through the Vaccine after having had the Small- 
pox, proves likewise, that the infection can be occasionally ab- 
sorbed, even without any previous injury to the cuticle. In fact 
this must be frequently the case among the cows in its communi- 
cation from the hands of milkers ; aad why should not the same 
occur in the human species ? 

On Saturday the 8th of May, Dr. Sermon vaccinated the daugh- 
ter of Mr. E. of five months old, on the right arm above the el- 
bow, which not appearing to have succeeded, was repeated in a 
few days in the other arm. This last attempt altogether failed ; 
but about eight days from the first trial, a pock commenced its 
progress, going through its various stages with great regularity, 
and at the present period (June 7th) a perfect scab exifls upon the 
part. 

Mrs. E. was accustomed to lay the child constantly upon her 
left arm, so, as that the Vaccine pock on the right arm of the 
child was in contact with Mrs. E's left arm above the elbow. No 
abrasion or scratch of the cuticle existed, nor can the minutest 
trace of such having been the case, be discovered. On Saturday 
29th of May (or about two weeks from the commencement of the 
Vaccine pock in the child) a pimple was evidently progressing* 
with considerable itching. As this itching had been perceived, 
but not attended to, for two or three days previously, we may 
safely state this day as the third from the absorption of the infec- 
tion. On Sunday (the fourth day if my conjecture is right) she 
felt considerably indisposed with heaviness of the limbs, fever, 
pain of head and back ; pain and swelling of the axillary glands, 
which still continue slightly, all indicating a constitutional in- 
disposition. 



i.49 

On Wednesday (seventh day) an areola commenced, and was 
at its height as large as a dollar on the eighth and ninth days, 
after which it gradually declined. This day, (Monday June 7th, 
the twelfth of the disease) a scab is commencing in the centre. 
The pock is deprefTed in the centre, is perfectly circular, with 
edges raised and flat surface ; some limpid matter is still evident, 
part of which I employed for Vaccination, but it failed of taking 
effect. 

This lady was inoculated twenty years ago by the late Dr. 
Glentworth, and had at least two hundred pustules in her face 
alone, as her mother informed me. Her imagination could 
scarcely have induced a belief of the symptoms, if they had not 
actually existed. 



THE following case which has resisted the action of Variolous 
infection, I introduce from its extraordinary rapidity: 

On the 26th and 31st of May > I vaccinated Lewis Calansalin- 
go, a black child of six years of age, a Dispensary patient, with 
infection of thirty-two, and of three days old, ineffectually. At 
. the same time I also vaccinated his sister of four months with the 
same matter. In this case the last attempt succeeded and pro- 
gressed finely. On the eighth day, I vaccinated her brother with 
fluid matter from the arm. This took effect, and on the sixth 
day I obtained matter from it. It was a perfect pock in every 
respect. On the 14th June (the eighth day) a perfectly hard 
dark coloured scab was completely formed ; no indisposition at- 
tended, and no hardness had existed around the base of the tu- 
mor; so that I am fatisfied there was no areola. On the ele- 
venth day the scab was quite black, when I inoculated him by 
three punctures, which produced a slight inflammation for three 
or four days, and then dried away. The scab came off about the 
14th or 15th day. 






THE following outlines of a case which occurred to Dr. Otto, T, 
introduce, to shew the Vaccine is not to be regarded as a perfect 
preservative against Small-pox, if the system has been exposed to 
the contagion before the Vaccine has exerted its full effect. 

On the 30th January, Miss P. was attacked with fever, &c. 
which continued the two following days, when an eruption of the 
Small-pox took place, between two and three hundred of which 
filled. Her sister, who never had had the disease, was constant- 
ly exposed to the contagion till the 3d of February, when she was 
Vaccinated. The symptoms of constitutional disease occurred 

[ '9 ] 



150 

with more than usual violence on the tenth, eleventh and twelfth' 
days, when they entirely ceased. On the evening of the sixteenth 
day, she had a chill, succeeded by fever during th»e night, though 
trifling compared with the previous attack ; the next morning an 
eruption of Small-pox occurred to the amount of one hundred, of 
which only two filled. 

Was the Small pox in this inflance moderated by the Vaccine ? 



I think I have found no difference in the susceptibility of the 
systems of whites and blacks, to the impression of the Vaccine. 

From what I can collect, I think fifteen hundred or two thou- 
sand persons in this city, must now have been subjected to the in- 
fluence cf the Vaccine, of which probably one hundred and fifty 
may have been tested with Variolous infection. 

It has appeared to me, that whenever the Vaccine is received 
by a person, who has previously undergone the Small-pox, it runs 
its course more rapidly than usual. 

The Warm months appear to have nearly suspended the fur- 
ther progress of Vaccination for the present. L may now ask 
where are our reservoirs for its future continuance? Those who 
imagined it was possible to keep it up in our charitable institu- 
tions, have taken no pains to realize their ideas ; which ideas 
have ten'ied to subvert the attempts to establish a Vaccine 
Institution. The necessity of such an Institution will, I ap- 
prehend, be soon felt, which I hope will lead to its speedy form- 
ation. 

This disease has yet to struggle with much opposition : — Man^ 
yet doubt its efficacy, which I can only account for, from the know- 
ledge that some of our Practitioners still persevere in the practice 
of inoculation. This apparent proof of their own want of faith in 
it, must certainly bias those who look up with deference to their 
medical opinions. The testimonial of our oldest Physicians 
Would strongly tend to accelerate its progress. With Mr. Ring 
we may say, " It is no want of candour to affirm that those who 
are hostile to Vaccine inoculation are total strangers to it ; those 
who are doubtful, are almost total strangers to it ; and I defy the 
whole world to produce one single instance of a person that has 
had any experience in the disease, **o is not a decided friend to 
the practice." See p. 720. 



T HAVE it fortunately in my power before concluding these ob- 
servations, to give an important document relative to the domes- 



i 5 i 

tic origin of the Vaccine among some cows in the neighbourhood 
of Philadelphia. I regret the information is not more extended, 
as it is of so interesting a nature to our inhabitants ; it is extract- 
ed from a letter of Dr. James Reynolds to me, dated PhiladeU 
phia, June 28, 1802, and is as follows: 

'* Early in March having Vaccinated Mr. Harwood's little 
son, at Mr. Bache's seat at Settle; the family, after my departure 
recollected that a young heifer on the estate had sores on her teats. 
On my next visit, in six or eight days, they mentioned the cir- 
cumstance ; the parts were by that time unfortunately covered 
by dry incrustations. 

" The idea however, naturally occurred, that as the habits 
and constitution of the cow, (some varieties of which are indige- 
nous) are nearly or precisely the same in Pennsylvania as in Bri- 
tain, by analogy, the same affections of the system are like to 
exist, and of course, the Cow-pox. 

(< To ascertain this, I spent some time in fruitless search, 
among the people who bring milk to our markets ; most of whom 
were shy, and offended by my inquiries. At last, one Mulvaney, 
who supplies my house, informed me, that a cow of his had sore 
teats, but he " guessed they were only scratched with briars." 
I called at his farm that evening, and had the gratification of pro- 
curing a considerable quantity of matter*. The next day I insert- 
ed portions'of it in three cases, which exhibited the most perfect 
appearances in all their stages. I have since used none but what 
is derived from this source, and have, by the desire of sceptical 
parents, successfully subjected several to the test of Variolous in- 
fection. " 






The following extract of a letter from Doctor Samuel Brown, 
of Lexington, (Kentucky), to Mr. John Vaughan, dated June 
10th, will certainly afford pleasure to every humane mind. 

" It will give you satisfaction to hear that the Jennerian ino- 
r< culatioa has gone on here with astonishing rapidity. Many 
** thousands have passed through that disease. People of all de- 
" scriptions communicate the infection, and although it is to be 
lt apprehended that some spurious cases may have occurred, un- 
" der the management of such untutored Practitioners, yet it is 
" believed that the genuine disease is pretty generally known and 
*'* diffused. Not less than one hundred and fifty thousand of our 

* This communication would have bern rendered much more valuable, by 
an account of the appearance of the disease in the cow t and o£ its supposed 



152 

: inhabitants, have never had the Small~pcx, What obligations 
do we not owe to Doctor Jenner, for the discovery of so safe 

. and easy a mode of escaping the ravages of that horrid dis- 
temper." 



By a letter from Mr. William Dunbar, dated " Natches, 30th 
May, 1802," to Mr. John Vaughan, we have the pleasing in- 
formation of the certain introduction of the Vaccine into that place. 
The prelude I hope of the final extinction of Small-pox in that 
part of America, 



I SHALL here conclude with a short remark on the still exist- 
ing prejudices of many against inoculation generally, under a 
false impression that, as all diseases are in the hands of the Al- 
mighty, it is a species of impiety to tempt him, by thus usurp- 
ing his prerogative in producing a disease, which probably 
might have been escaped ! But should not all who argue thus, to 
act consistently, refuse medical assistance in every instance ? Does 
not accepting a dose of physic from the hands of a Physician, argue 
the same impiety, inasmuch, as without fuch aid, health may be 
restored by the blessing of Providence? But the fact is, the 
error consists in blindly refusing to employ the means which are 
placed in our power, to remove the evils to which we are expo- 
sed.— -That same bounteous Creator who has provided us with 
Food necessary to our existence, has likewise supplied those medi- 
cines which are administered to our relief in a state of disease ; 
and has given reason to man, to enable him to distinguish what 
may benefit, from what may injure him. Inoculation then should 
be viewed as a medicine, disagreeable in itself, yet administer- 
ed to escape a greater evil.— -In the same light ought we to view, 
and to prefer, this new species of inoculation ; as it possesses every 
advantage, exempt from the disadvantages, of that dreadful dis- 
ease the Small-pox. 






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Quickfilver Tray and its Appendages. 

jThe above is now Printing on Subscription, 
And will be fhortly Publifhed 

By James Humphreys, 

On the following Conditions, viz. 

On a good Paper and handsome Type in two neat Pocket Volumes. 

The Price to Suhfcribers will be Three Dollars and aa Half for it neatly 
bound and lettered. In Boards Three Dollars. 

{£f* To Non-fubfcribers the Price will be ccnfiderably advanced. 

SUBSCRIPTIONS to the foregoing Works are received by faid HUMPHREYS; 
gt the NJV. Corner of Walnut and Dock-ftreets* 



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7/23/12 



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